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Depressive automatic processes as vulnerability markers in depression Cheung, Elsie 1991

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DEPRESSIVE AUTOMATIC PROCESSES AS VULNERABILITY MARKERS IN DEPRESSION by ELSIE CHEUNG  B.A., The U n i v e r s i t y of B r i t i s h Columbia, 1982 M.A., The U n i v e r s i t y of B r i t i s h Columbia, 1987 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES DEPARTMENT OF PSYCHOLOGY  We accept t h i s t h e s i s as conforming to the r e q u i r e d s t a n d a r d  THE UNIVERSITY OF BRITISH COLUMBIA October 1991 ©Elsie  Cheung, 1991  In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department  or  by his  or  her  representatives.  It  is  understood  that  copying or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department of  ?<L^CJ%ol/l<2j Lj  The University of British Columbia Vancouver, Canada Date  DE-6 (2/88)  (QtT  f/f  /  ii Abstract Previous cognitive  r e s e a r c h has found  vulnerability.factors  this  l a c k of support  into  effortful  propose would  support f o r  i n depression.  I argue  i s due t o t h e use o f t a s k s  processes,  that support  be found  little  as s e e n  i n previous  that tap  research.  for cognitive vulnerability  by u s i n g t a s k s w h i c h t a p i n t o  that  I  factors  automatic  processes. Depressive tasks:  automatic  dichotlc  processes  listening,  were a s s e s s e d  p r o b e d e t e c t i o n , and  memory t a s k s .  For the d i c h o t l c  shadowed b r i e f  n e u t r a l passages while  positive-content channel. word  "press" presented  task,  latencies  pairs  screen, one  words were p l a y e d  Concurrently,  Detection  were u s e d :  F o r the probe d e t e c t i o n presented  on a computer  o f t h e s c r e e n , and  Three types  o f word  pairs  n e u t r a l - n e u t r a l , d e p r e s s i o n - n e u t r a l , and Subjects  were a s k e d  t o read  They were a l s o r e q u i r e d t o d e t e c t  •"+", w h i c h sometimes a p p e a r e d Detection  memory t a s k , of  unattended  on a computer s c r e e n .  i n t h e upper h a l f  i n t h e bottom h a l f .  positive-neutral.  words.  subjects  d e p r e s s i o n - and  i n the  intermittently  were r e c o r d e d .  one a p p e a r i n g  task,  implicit  s u b j e c t s were r e q u i r e d t o d e t e c t t h e  o f words were b r i e f l y  appearing  aloud.  listening  by t h r e e  half  latencies  i n either  t h e t o p word  the presence  location  were r e c o r d e d .  of a  of the  For the i m p l i c i t  o f t h e s u b j e c t s were p r e s e n t e d  with a  words and were r e q u i r e d t o r a t e e a c h word on how much  they  liked  each word.  Four  types  o f words were  used:  list  ill  depress I o n - r e l a t e d , and  types  happiness-related,  of d i s e a s e s .  generate.eight  types  o£ flowers,  These s u b j e c t s were then asked t o  exemplars for each word type.  The other h a l f  of the s u b j e c t s were simply asked to generate e i g h t exemplars f o r the word types. Depressive  effortful  r e p o r t of c o g n i t i o n s . report questionnaires:  processes  were d e f i n e d as s e l f -  This was assessed  by three  self-  D y s f u n c t i o n a l A t t i t u d e Scale,  Automatic Thoughts Questionnaire,  and the Hopelessness  Scale. Three groups of s u b j e c t s were used:  currently  depressed p a t i e n t s (n=20), remitted depressed i n d i v i d u a l s (n=20),  and nondepressed I n d i v i d u a l s (n=20).  The c u r r e n t l y  depressed group c o n s i s t e d of 13 women and 7 men, the r e m i t t e d depressed group c o n s i s t e d of 16 women and 4 men, whereas the nondepressed group c o n s i s t e d of 13 women and 7 men.  T h e i r ages ranged from 23 to 65 years, with an o v e r a l l  average of 3 9 . 9 (SD = 1 1 . 2 8 ) years, I n d i v i d u a l l y on each of the tasks.  s u b j e c t s were t e s t e d Three months a f t e r  t e s t i n g , they were asked t o complete the Beck  Depression  Inventory. Four main hypotheses were examined: depressed  i n d i v i d u a l s would show a b i a s for depression-  r e l a t e d s t i m u l i on the automatic t a s k s ; depressed  (a) c u r r e n t l y  (b) remitted  i n d i v i d u a l s ' p a t t e r n of performance on the  automatic tasks would resemble that of the c u r r e n t l y depressed p a t i e n t s ; (c) remitted depressed I n d i v i d u a l s '  iv pattern that  of p e r f o r m a n c e  of t h e  depressive  on t h e e f f o r t f u l  nondepressed automatic  individuals;  processes  and  would be  f o l l o w - u p d e p r e s s i v e symptoms.  Analyses  regression  The  analyses  supported. dichotic  The  second  listening  supported,  of t h e  m e t h o d o l o g y , and  hypothesis  task.  whereas t h e  Implications  dlscussed.  were u s e d .  The  clinical  of v a r i a n c e hypothesis  hypothesis was  assessment  procedures  and was  not  f o r the  was  not  t o schema t h e o r y ,  of  of  only supported  fourth hypothesis  results  resemble  (d) measures  predictive  first  was  third  t a s k s would  supported.  vulnerability were  V  Table  of C o n t e n t  Abstract Table  11  of content  v  List  of Tables  .  X  List  of F i g u r e s  List  of Appendices  xl .xii  Acknowledgments Chapter  1:  xiii  I n t r o d u c t i o n and o v e r v i e w  Vulnerability  to depression  . . . . . .  1  .  1  . . . .  3  Overview of c h a p t e r s Chapter  2:  T h e o r e t i c a l and m e t h o d o l o g i c a l  research  on c o g n i t i v e v u l n e r a b i l i t y  Theoretical  Depressive  schema  Teasdale's  Methodological  o£ dtepiession  activation  p r e d i c t i o n s from schema  issues  self-report  questionnaires  using  t h e ATQ and HS  .  HS s t u d i e s  . . . . 18  26  task  29 mood c o n g r u e n t ? 30 32 32  memory measures encoding  theory  . . . . 16  27  DAS, ATQ, and HS r e s p o n s e s s o l e l y  Self-referent  theory  on c o g n i t i v e v u l n e r a b i l i t y 25  Studies  Summary o f DAS, ATQ,and  5  19  .  t h e DAS  using  ,  . 10  using  Studies  ,  9  Studies  Are  ,  theory  Review o f r e s e a r c h using  ,  theories  differential  Theoretical  Studies  5  model  Beck's schema  3:  5  issues  a cognitive  Chapter  issues l n  studies  33  vi Other memory s t u d i e s  37  Summary o£ f i n d i n g s from memory s t u d i e s  38  Studies examining d i f f e r e n t i a l r e l a p s e r a t e s  39  Summary of s t a t u s of c o g n i t i v e v u l n e r a b i l i t y r e s e a r c h  . 39  P o t e n t i a l confounds i n the c o g n i t i v e v u l n e r a b i l i t y measures Chapter 4:  40  Automatic processes  D e f i n i t i o n s of automatic Automatic processes L i t e r a t u r e review  as v u l n e r a b i l i t y markers. 43  and e f f o r t f u l processes  . . . 43  as p o t e n t i a l v u l n e r a b i l i t y markers. 45  on automatic  in depression  and e f f o r t f u l  processes  .  46  D i f f e r e n t i a l e f f e c t s of d e p r e s s i o n on automatic and  e f f o r t f u l tasks  47  Automatic p r o c e s s i n g s t u d i e s i n d e p r e s s i o n S e l f - r e f e r e n t encoding  task s t u d i e s  48 49  .  Studies examining p e r c e p t u a l b i a s e s  51  Studies examining a t t e n t i v e b i a s e s  52  V u l n e r a b i l i t y s t u d i e s examining automatic Chapter 5: method  Chapter 6: Subjects Measures  , 56  Statement of research problem and o v e r a l l  . . . . . .  Conceptual  processes  . . .  d e s c r i p t i o n of tasks used  58 59  Method  64  .  64 . .  64  DSM-III-R diagnoses  64  Schedule f o r A f f e c t i v e Disorders and S c h i z o p h r e n i a  65  Hamilton R a t i n g Scale f o r Depression  66  vii  Beck  Depression  Inventory  Subject  classification  Subject  characteristics  Demographic  Overall Chapter  .  .  .  .  .  .  .  .  .  .  .  .  68  70  criteria .  and s o c i a l  Depression data  .  . 72 73  factors .  . ... . . . .  .  .  .76 78  procedure  7:  Dichotlc  listening  Method  .  Materials  .  .  .  80  task .  .  .  .  .  .  .  .  .  .  .  .  81  .  81  Stories  81  Unattended word  81  Recognition  83  Reaction  task  . 84  time probe  .84  Procedure  , . 87  Hypotheses  88  Results Analyses Probe  reaction  Correlation Shadowing  Chapter  8:  90  analysis  task  88 88  time  performance  Recognition Summary  . . . . . .  . . . .  . . . .  .  .  .  .92 92  performance  95  . Visual  probe  97  task :  Method  98  Materials Procedure Hypotheses  98  . . . . . . . . . . .  .  .  101  .  102  vlli  Results Analysis  1  0  3  1  0  3  M i s s i n g data  103  Detection  104  latencies  Summary Chapter 9:  104 i m p l i c i t memory task  .  Method  107 107  Materials  107  Procedure  109  Hypotheses  110  Results  I l l  Analysis  I l l  Scoring  I l l  I m p l i c i t memory task  112  E x p l i c i t memory task  115  Summary chapter  10:  115 s e l f - r e p o r t of c o g n i t i o n s  Method  118 118  Measures  .  118  Automatic Thoughts Questionnaire  118  Hopelessness Scale  119  D y s f u n c t i o n a l A t t i t u d e Scale  120  Procedure  121  Hypotheses  121  Results  121  Analysis DAS  . . . .  121 .  123  ix ATQ  123  HS  123  Summary Chapter 11:  124 Follow-up data  125  Method  .  Materials  125 125  Beck Depression Inventory  125  Procedure  125  Hypothesis  126  Results  126  Analysis  .  126  Subjects Who mailed the q u e s t i o n n a i r e s  127  Data t r a n s f o r m a t i o n  127  M i s s i n g data. . Regression a n a l y s i s r e s u l t s Summary Chapter 12:  . .  . . . ^  129 129 131  Discussion  133  Summary of f i n d i n g s  133  P o t e n t i a l l i m i t a t i o n s of work  135  P o t e n t i a l c o n t r i b u t i o n s of work . . . . . . . . References  ^ . .  137 140  X  List  of Tables  Table 1:  Demographic c h a r a c t e r i s t i c s of s u b j e c t groups . 74  Table 2:  Depression measures at time of t e s t i n g  Table 3:  Stimulus words f o r d i c h o t l c l i s t e n i n g task. . . 82  Table 4:  D e t e c t i o n l a t e n c i e s from the d i c h o t l c  . . . .  77  l i s t e n i n g task i n msec  89  Table 5:  Mean number of shadowing e r r o r s  93  Table 6:  Mean number of words c o r r e c t l y recognized  Table 7:  Stimulus words f o r v i s u a l probe task  Table 8:  Mean probe d e t e c t i o n l a t e n c i e s , i n msec  Table 9:  Number of words generated  . . .  99 105  i n the i m p l i c i t  task  113  Table 10: Number of words r e c a l l e d  l n the e x p l i c i t  task  116  Table 11:  Questionnaire scores  Table 12:  Follow-up Beck Depression  Table 13:  C o r r e l a t i o n s between p r e d i c t o r v a r i a b l e s with Beck Depression  94  122 Inventory scores . .128  Inventory scores  . .130  xl List F i g u r e 1:  Detection task  of F i g u r e  latencies  from the d i c h o t l c l i s t e n i n g 91  xii L i s t of Appendices Appendix A:  Schedule f o r A f f e c t i v e D i s o r d e r s and Schizophrenia  .  .  Appendix B:  Hamilton Rating Scale f o r Depression  Appendix C:  Interview  .  .  .  .158  .  .165  probes f o r the Hamilton Rating  Scale f o r Depression Appendix D:  Beck Depression  Appendix E:  DSM-III-R diagnoses Episode  Appendix F:  172 .176  Inventory f o r Major  Depressive 180  and Dysthmia  L i s t of medications depressed  f o r c u r r e n t l y and r e m i t t e d 183  groups  Appendix G :  Consent forms  185  Appendix H:  Interview  188  Appendix i : s t i m u l i Appendix J :  Analyses  190  f o r d i c h o t l c l i s t e n i n g task of v a r i a n c e  for dichotic  listening 193  task Appendix K:  Anaysis  of v a r i a n c e f o r probe d e t e c t i o n 196  task Appendix L:  Analyses  of v a r i a n c e  f o r i m p l i c i t memory  task  198  Appendix M:  Automatic Thoughts Q u e s t i o n n a i r e  200  Appendix N:  Hopelessness Scale  202  Appendix 0 :  D y s f u n c t i o n a l A t t i t u d e Scale  205  Appendix P:  Analyses  of v a r i a n c e and covariance  for the  self-report questionnaires Appendix Q:  C o r r e l a t i o n t a b l e s of measures by groups .  209 .212  xiii Acknowledgements A t h e s i s i s never produced by a s i n g l e i n d i v i d u a l . appreciate  t h i s opportunity  to acknowledge those  I  who  contributed. I would l i k e to thank Dr. R.  Remick and  the s t a f f  Ward West 1 of U n i v e r s i t y H o s p i t a l - U n i v e r s i t y of Columbia s i t e  for t h e i r assistance  of  British  ln r e c r u i t i n g subjects.  Profound thanks are extended to Jane Dunlop, whose extremely capable r e c r u i t i n g and process a smooth  o r g a n i z a t i o n a l s k i l l s made t h i s  one.  I would l i k e to thank my Dobson, Peter  Graf,  e s p e c i a l l y indebted Finally, who  and  t h e s i s committee - K e i t h  D i m i t r l Papageorgis.  to Peter  Graf and  I would l i k e to thank my  contributed  I am  K e i t h Dobson. f a m i l y and  to t h i s p r o j e c t i n I n f i n i t e ways.  friends,  1  Chapter  1:  I n t r o d u c t i o n and  Vulnerability The  on  Unipolar  depression,  depression  unipolar depression  with  research  writers  To  no  i t s state  advances" extent,  has  Impressive  i n the  o f mania  29),  optimism  approaches.  the  of d e p r e s s i v e e p i s o d e s ,  treatment  chronlcity  and  recurrence  Approximately depression  do  of d e p r e s s i o n successfully experience  Despite  not  20%  1985,  go  1980).  on  progress",  preface). because  treatments  the  with and  these ^impressive r a t e s i n however, problems been  of p a t i e n t s s e e k i n g  (Klerman,  Ignored. treatment  for  t o have a c h r o n i c  Even among  of  course  those  t r e a t e d , t h e m a j o r i t y of p a t i e n t s q u i c k l y  a r e t u r n of major symptoms.  treated  depressed  h i g h as  16%  1981).  Furthermore,  w i t h i n one  year  the  (Kovacs,  greater the  r e c u r r e n c e r a t e s as  number  relapse,  with the  time  s t u d i e s of  Rush, Beck, &. H o l l o n ,  of d e p r e s s i o n , t h e g r e a t e r t h e  episode  Follow-up  p a t i e n t s have p r o d u c e d  episodes  succeeding  "true  "tremendous  have l a r g e l y  r e m i t , but  w i t h some  pharmacological  psychological  as  hypomania.  i s warranted  l e d to h i g h l y e f f e c t i v e  outcome r a t e s f o r b o t h  or  decades. is defined  optimism,  (Beckham & L e b e r ,  such  few  thesis,  as s h o w i n g p.  e x p l o s i o n of  past  of t h i s  episodes  (Hammen, 1985,  "exciting  research  topic  prior  summarizing  a certain  the  shows an  i s marked by an a i r o f  breakthroughs" and  Depression  mental h e a l t h l i t e r a t u r e  research  This  to  Overview  of  previous  likelihood  of  between r e l a p s e s l e s s e n i n g w i t h  (Angst  e t a l . , 1973).  each  2 These f i g u r e s suggest that once depressed, there  is a  strong tendency to remain i n or relapse back i n t o depression.  Implicit in this  i s the e x i s t e n c e  of  v u l n e r a b i l i t y - some d i s p o s i t i o n that maintains or predisposes  the  i n d i v i d u a l to depression.  t h e s i s i s to address the a focus and  The  issue of v u l n e r a b i l i t y .  (e.g., Teasdale,  to depression.  L i k e other  1988), I do not c o n c e p t u a l i z e  i n p u r e l y c o g n i t i v e or p s y c h o l o g i c a l terms. to depression  To  provide  researchers  vulnerability  Vulnerability  i s l i k e l y to be a complex i n t e r p l a y of  g e n e t i c , b i o l o g i c a l , s o c i a l , and Nevertheless,  psychological factors.  i n the absence of knowledge of  r e l a t i o n s h i p s of these i n t e r a c t i o n s , one  specific  must l i m i t one's  of i n q u i r y . The  the  of t h i s  working framework, t h i s t h e s i s adopts a  cognitive perspective  field  aim  reasons f o r choosing  following.  the c o g n i t i v e model i s one  of  most i n f l u e n t i a l models In research on d e p r e s s i o n  at  present.  First,  the c o g n i t i v e p e r s p e c t i v e  Second, i t d i r e c t l y addresses the  are  the  issue of  v u l n e r a b i l i t y , thus p r o v i d i n g a framework f o r the study of vulnerability.  L a s t , the  l i t e r a t u r e provides  preliminary  evidence of v u l n e r a b i l i t y w i t h i n a c o g n i t i v e model.  3 overview of chapters In chapter 2, I review the research vulnerability.  on c o g n i t i v e  A d e s c r i p t i o n of Beck and h i s c o l l e a g u e s '  c o g n i t i v e model (Beck, 1967, 1976; Beck, Rush, Shaw, & Emery, 1979) depressive  is first  presented.  In t h i s c o g n i t i v e model,  schemata are implicated as v u l n e r a b i l i t y f a c t o r s  ln depression. described  Next, schema and r e l a t e d t h e o r i e s are  ( c f . Markus, 1977; Teasdale, 1 9 8 8 ) .  of these t h e o r i e s , a l i s t supportive  On the basis  of p r e d i c t i o n s t h a t would be  of the c o n s t r u c t v a l i d i t y of schemata Is  generated.  Then, research  s t r a t e g i e s used i n the area of  c o g n i t i v e v u l n e r a b i l i t y are described  and c r i t i q u e d .  In chapter 3, I review the l i t e r a t u r e on c o g n i t i v e vulnerability.  The review i s organized  measures used i n the l i t e r a t u r e . questionnaires,  i n terms of the  These a r e :  self-report  memory measures, and d i f f e r e n t i a l  to c o g n i t i v e therapy and pharmacotherapy.  response  The c o n c l u s i o n  from the review i s that only weak and i n c o n s i s t e n t support has  been found.  are  discussed. The  P o t e n t i a l confounds i n the measures used  aim of chapter 4 i s to introduce  depressive  the n o t i o n  that  automatic processes are v i a b l e candidates f o r  vulnerability factors.  F i r s t , the t h e o r e t i c a l d i s t i n c t i o n  between automatic and e f f o r t f u l processes i s d e s c r i b e d . Second, r e s e a r c h i n depression  that shows that these two processes e x i s t  i s outlined.  T h i r d , research  on automatic  4 processes  in depression  on automatic  processes  i n chapter work. The  is described.  The  literature  review  as v u l n e r a b i l i t y f a c t o r s f o l l o w s .  5, I provide an overview of my  own  empirical  I begin with a statement of the research problem.  o v e r a l l procedure i s then d e s c r i b e d , followed by  the  s e c t i o n on s u b j e c t s . In chapters e m p i r i c a l work.  7 to 11,  I d e s c r i b e the various p a r t s of  In chapters  7 to 9,  assessment of d e p r e s s i v e automatic  my,  I describe the  processing.  Chapter 7  contains the r e s u l t s from the d i c h o t i c l i s t e n i n g  task.  Chapter 8 contains the r e s u l t s from the v i s u a l probe task, while chapter  9 c o n t a i n s the r e s u l t s from the  memory task.  In chapter  effortful  10,  I r e p o r t the assessment of the  p r o c e s s i n g , as d e f i n e d by the s e l f - r e p o r t of  cognitions via questionnaires. d e s c r i b e the follow-up The  implicit  f i n a l chapter  i n chapter  i s the general d i s c u s s i o n . summarized.  provided.  The  L i m i t a t i o n s of the  L a s t , i m p l i c a t i o n s of t h i s  to schema theory, v u l n e r a b i l i t y methodology, and p r a c t i c e are  11, I  data.  t h e s i s f i n d i n g s are f i r s t f i n d i n g s are d i s c u s s e d .  Finally,  research  clinical  5  chapter 2:  T h e o r e t i c a l and  Methodological  issues  in Research on C o g n i t i v e V u l n e r a b i l i t y The  aim  of t h i s chapter i s to provide  background for r e s e a r c h T h e o r e t i c a l issues are  a  conceptual  on c o g n i t i v e v u l n e r a b i l i t y . f i r s t discussed.  A d e s c r i p t i o n of  the c o g n i t i v e model of depression  provides  background.  issue of v u l n e r a b i l i t y ,  depressive  More s p e c i f i c to the  schemata are then d e s c r i b e d .  the  general  Based on  s e c t i o n , a l i s t of p r e d i c t i o n s supportive  of the  that  construct  v a l i d i t y of c o g n i t i v e v u l n e r a b i l i t y i s o u t l i n e d . Next, methodological issues i n c o g n i t i v e v u l n e r a b i l i t y are d i s c u s s e d . research  This s e c t i o n i s organized  s t r a t e g i e s used i n the Theoretical  A Cognitive  according  to  the  literature. Issues  Model of Depression  As measured by the sheer number of c i t a t i o n s , Beck his  colleagues'  c o g n i t i v e model (Beck, 1967,  Rush, Shaw, & Emery, 1979)  represents  one  1976;  Beck,  of the most  i n f l u e n t i a l p s y c h o l o g i c a l approaches to depression Beck was  among the  depression of a f f e c t .  first  t h e o r i s t s to c o n c e p t u a l i z e  first  observed that h i s depressed  are c h a r a c t e r i s t i c a l l y s e l f - d e p r e c i a t i n g and pessimistic  (Beck, 1963,  these negative others  and  to date. unipolar  as p r i m a r i l y a d i s o r d e r of t h i n k i n g r a t h e r He  1964).  evaluations  He  and  than  patients  unrealistically  f u r t h e r observed  that  are o f t e n not s u b s t a n t i a t e d  are h i g h l y r e s i s t a n t to r e f u t a t i o n .  by  To Beck,  6 t h i s p a t t e r n suggested that depressed from d i s t o r t e d c o g n i t i v e  individuals suffer  processes.  To e x p l a i n the p s y c h o l o g i c a l  substrate  of depression,  the model (Beck, 1976; Beck e t a l . , 1979) postulates concepts: faulty  the c o g n i t i v e t r i a d , c o g n i t i v e d i s t o r t i o n s or  information  processing,  t r i a d c o n s i s t s of patterns i n d i v i d u a l s to regard future  three  i n negative  self-talk  and schemata.  The c o g n i t i v e  of t h i n k i n g that induce depressed  themselves, t h e i r world> and t h e i r  terms.  The t r i a d  of depressed i n d i v i d u a l s .  i s manifest i n the For- example, depressed  i n d i v i d u a l s o f t e n view themselves as unworthy, inadequate, and  defective.  They o f t e n see the world as making  continuous unreasonable demands on them. their  They i n t e r p r e t  i n t e r a c t i o n s with the environment as representing  defeat.  Furthermore, depressed  i n d i v i d u a l s often expect  t h e i r problems to continue i n d e f i n i t e l y . attempt t o a l l e v i a t e t h e i r d e p r e s s i o n ,  When they do  they often p r e d i c t  failure. The  depressed i n d i v i d u a l s ' tendency towards  t h i n k i n g occurs a u t o m a t i c a l l y ,  negative  i s o f t e n not s u b s t a n t i a t e d by  o b j e c t i v e evidence, and stands s t e a d f a s t to r e f u t a t i o n .  To  e x p l a i n the pervasiveness and r e s i l i e n c e of t h i s kind of t h i n k i n g , Beck p o s t u l a t e d  t h a t depressed i n d i v i d u a l s make a  s e r i e s of c o g n i t i v e d i s t o r t i o n s or s t y l i s t i c e r r o r s i n t h e i r thinking.  Examples of these are s e l e c t i v e a b s t r a c t i o n (the  process of f o c u s i n g on s e l e c t i v e f e a t u r e s of the s i t u a t i o n , despite  the presence of more s a l i e n t  features) and  7 magnification f e a t u r e s are are  and  minimization  magnified  (a p r o c e s s  or d i s t o r t e d ,  by  while  which  negative  positive  features  downplayed). Both the  products 1976;  triad  arising  Hollon  and  from  & Kris,  the  the  distortions  operations  1984).  of t h e  s t r u c t u r e s which  function like  screening  out,  Integrating  stimuli.  Schema t h e o r y  and  schemata  Schemata a r e d e f i n e d  cognitive  coding,  are c o n s i d e r e d  i s developed  to  be  (Beck,  as  templates  in  environmental  more f u l l y  i n the  next  section. To  Beck, d e p r e s s i v e  c o g n i t i o n s are  d e p r e s s i v e d i s o r d e r s i n two that  depressive  symptomatology  direct  (Beck, 1976;  situations. erroneously or  she  as  example,  resulting  The  the  from d e p r e s s i v e become l e t h a r g i c  They r a r e l y  take  overcome t h e i r help account  f o r the  The  or she  other  manifestations  components  are  their  individual r e j e c t e d , he  sadness engendered  by an a c t u a l  of d e p r e s s i o n  are  a l s o seen  cognitions.  Depressed  because they  predict  l a c k the  depression.  depressive  Is b e i n g  initiative  believe that they  maintained  ( m i s ) a p p r a i s a l of  i f a depressed  Individuals  they  1  affective  Motivational aspects  the  of  merely secondary  I n t e r p r e t s t h a t he  would e x p e r i e n c e  rejection.  are  of d e p r e s s l v e s  For  core  Beck  to unipolar  Beck e t a l . , 1979).  cognitions.  results  First,  t h i n k i n g forms t h e  symptoms of d e p r e s s i o n of d e p r e s s i v e  ways.  central  failure.  to help themselves  because  personal  to  Finally,  the  resources  c o g n i t i v e model  v e g e t a t i v e s i g n s of d e p r e s s i o n .  It  can  8 suggests that the result  from the  low  energy and  psychomotor r e t a r d a t i o n  f u t i l i t y experienced by  p r e d i c t i o n s that a l l e f f o r t s w i l l Second, the cognitions  maintenance, and  lead to  eventual a l l e v i a t i o n of  c o g n i t i v e model p o s t u l a t e s  depressive  not  onset,  depression.  c l e a r l y s p e c i f i e d , the  that schemata c o n s t i t u t e a  p r e d i s p o s i t i o n to depression  (Beck et a l . , 1979;  Kovacs &  i t i s assumed that negative e a r l y  childhood  e x p e r i e n c e s are r e s p o n s i b l e depressive  failure.  c o n t r i b u t i n g f a c t o r s i n the  Although the exact mechanisms are  Beck, 1978).  depresslves'  c o g n i t i v e model a l s o views  as key  schemata,  for i n i t i a l l y  schemata are  e s t a b l i s h i n g the  later activated  s p e c i f i c circumstances that are analogous to the experience r e s p o n s i b l e For  example, i f the  for the  initial  Inception  of the  experience was  parent, then a m a r i t a l separation  the  initial schemata.  l o s s of a  The  l i n k between  these s i t u a t i o n s might be the sense of l o s s of an  and  Once a c t i v a t e d , the  l i n k s to the  other depressive  Once a c t i v a t e d , the depressive by an  Intimate  schema invokes the  the d i s t o r t i o n s which, as d i s c u s s e d  • first  by  might be the t r i g g e r i n g  event f o r the a c t i v a t i o n of the schema.  relationship.  e a r l i e r , are  triad the  symptoms. schemata can be evoked  i n c r e a s i n g l y wider range of s t i m u l i , even those  l o g i c a l l y r e l a t e d to the depressive p o i n t , the  schemata.  dominated by negative thoughts.  be  These thoughts may  I n t r u s i v e , so that the  not  At t h i s  depressed p a t i e n t ' s t h i n k i n g appears to  r e p e t i t i v e and  may  i n d i v i d u a l has  become  9 d i f f i c u l t i e s s l e e p i n g or c o n c e n t r a t i n g on other t a s k s . These r e a d i l y a c c e s s i b l e depressive c o g n i t i o n s serve to r e i n f o r c e the depressed  p a t i e n t ' s b e l i e f s and p r e d i c t i o n s .  T h i s , i n t u r n , i n t e r a c t s i n a r e c i p r o c a l feedback loop with d e p r e s s i v e a f f e c t and depressed spiral  individual  other symptoms of depression u n t i l i s caught i n a continuous  the  downward  of d e p r e s s i o n .  In severe d e p r e s s i o n , the d e p r e s s i v e schemata e v e n t u a l l y become autonomous.  At t h a t stage, the schemata  are independent of e x t e r n a l s t i m u l i i s unresponsive  to changes i n h i s or her environment.  t h i s p o i n t , the depressed and  so that the I n d i v i d u a l At  i n d i v i d u a l ' s negative c o g n i t i o n s  b e l i e f s appear to be v e r i d i c a l r e p r e s e n t a t i o n s of  r e a l i t y to the p a t i e n t , even though they may  appear  f a r f e t c h e d to others or to the same i n d i v i d u a l when not depressed.  When the depressed  individual's  "personal  paradigm" Is reversed and r e a l i g n e d with r e a l i t y , d e p r e s s i o n s t a r t s to disappear. specifically  reversal  process  i n v o l v e s the i d e n t i f i c a t i o n and m o d i f i c a t i o n of  depressogenic Depressive  The  h i s or her  thoughts  and assumptions  (Beck et a l . , 1979).  Schema Theories  In the previous s e c t i o n , I d e s c r i b e how  depressive  schemata can be seen as key c o n t r i b u t i n g f a c t o r s to the onset and maintenance of a d e p r e s s i v e episode.  In other  words, d e p r e s s i v e schemata are c e n t r a l to the issue of vulnerability.  T h i s s e c t i o n e x p l i c a t e s schema theory,  since much of schema theory has been developed  under the  auspices first.  of Beck's c o g n i t i v e theory, t h i s Teasdale's  i s discussed  d i f f e r e n t i a l a c t i v a t i o n theory  (Teasdale,  1988), which p r o v i d e s an a l t e r n a t i v e but r e l a t e d account of schema, i s then d e s c r i b e d . from these t h e o r i e s are  Finally, predictions arising  presented.  Beck's schema theory.  Schemata, i n g e n e r a l , are  d e s c r i b e d as c o n t a i n i n g c o g n i t i v e g e n e r a l i z a t i o n s about the s e l f that are the culminations of past experiences 1977). the  For example, a shy person's self-schema  (Markus,  may  contain  i n f o r m a t i o n " f e e l nervous around s t r a n g e r s " , "am  with people",  and  "am  not l i k e l y to be l i v e l y at p a r t i e s " ,  i n the area of d e p r e s s i o n , the content self-schema  has  of the  information (Kuiper & MacDonald,  Sacco & Beck, 1985), whose content  discriminated  depressive  been defined as c o n t a i n i n g d e p r e s s i o n -  related s e l f - r e f e r e n t i a l 1983;  awkward  can  be  from other n o s o l o g i c a l groups (Beck,  Hollon £ K e n d a l l , 1980 ). c o n t a i n the content  Depressive  1967;  schemata, a d d i t i o n a l l y ,  of the premises and  assumptions  a s s o c i a t e d with p a i n f u l e a r l y childhood experiences & Beck, 1978; depressive may  Sacco & Beck, 1988), have experienced  The  sense of sadness and  may  result  be happy". succeed  (Kovacs  For example, a  an e a r l y l o s s of a  parent.  r e j e c t i o n engendered by the  loss  i n the premise that "I must be loved i n order to Another example i s the premise that "unless I  l n e v e r y t h i n g , I am a f a i l u r e " , which may  the e x c e s s i v e l y high, r i g i d standards early childhood.  Imposed  reflect  by parents i n  These p r e m i s e s have been c a t e g o r i z e d as  11 " d y s f u n c t i o n a l b e l i e f s " or "assumptions" Welssman & Beck, 1978).  Although  (Welssman,  an exhaustive  list  1980; of  these b e l i e f s has not been provided, examples are " I t i s important  that others approve of me"  and  unless i t Is p e r f e c t " (Welssman, 1980;  " I t i s not c o r r e c t  Welssman & Beck,  1978 ) . The structure  self-schema  has been viewed as a c o g n i t i v e  (Beck, 1976;  Segal, 1988;  MacLeod, & Mathews, 1988).  W i l l i a m s , Watts,  As a s t r u c t u r e , the I n d i v i d u a l  s e l f - e l e m e n t s or c o n s t r u c t s are organized with a high degree of  interrelation.  depressive s e l f  So i n the v u l n e r a b l e i n d i v i d u a l ,  the  Is l i n k e d with other s e l f c o n s t r u c t s such as  s e l f as mother, s e l f as spouse, and  so on.  I t i s assumed  that  i n t h i s c o g n i t i v e s t r u c t u r e , a c t i v a t i o n of one  element  will  spread to the other elements i n the s t r u c t u r e , thereby  lowering t h e i r a c t i v a t i o n t h r e s h o l d s (Anderson,  1983;  C o l l i n s & L o f t u s , 1975;  Because of  Higgins & Bargh, 1987).  t h i s spreading of a c t i v a t i o n and  the high degree of  c o n n e c t i v i t y among the elements, i t i s p o s s i b l e to a c t i v a t e the d e p r e s s i v e self-schema  by a c t i v a t i o n of the  neighboring s e l f - c o n s t r u c t s . et  other  This i s c o n s i s t e n t with Beck  a l . ' s (1979) s p e c u l a t i o n , d i s c u s s e d i n the  previous  s e c t i o n , t h a t d e p r e s s i v e schemata can be evoked even by s t i m u l i not l o g i c a l l y l i n k e d to the d e p r e s s i v e schemata. The  s e l f as a c o g n i t i v e s t r u c t u r e f o r m u l a t i o n i s  s i m i l a r to the a s s o c i a t i v e network model of memory (Bower, 1981)'.  Although  Bower's model Is not an account  of  clinical  12 depression,  I t I s w o r t h m e n t i o n i n g h e r e as  v e r s i o n of the Information  t h e o r e t i c a l groundwork f o r s c h e m a t i c  processing.  Bower p r o p o s e d t h a t t h e e f f e c t s o f  mood on c o g n i t i v e p r o c e s s e s can general  be  incorporated  within a  a s s o c i a t i v e n e t w o r k model of l o n g - t e r m memory  A n d e r s o n & Bower, 1974;  Collins  model assumes t h a t c o n c e p t s a r e nodes t h a t a r e  strongly related in their links.  For  example, the  by a node t h a t "cushion"  and  & L o f t u s , 1975). represented  connected t o each other  associations that d i f f e r  the  It provides a  in strength.  nodes " w h i t e "  or  by means o f  c o n c e p t " s o f t " may  I f the  particular conscious  strength  are  stronger represented nodes  is less strongly associated  "hungry".  with  A c t i v a t i o n of a p a r t i c u l a r i t s connected  a c t i v a t i o n of t h e s e c o n n e c t e d nodes r e a c h e s a  threshold, their  content  i s made a v a i l a b l e t o  awareness.  Bower a d d i t i o n a l l y p r o p o s e d t h a t t h e content  be  w i t h the  node i s assumed t o l e a d t o a c t i v a t i o n of nodes.  by i n d i v i d u a l  m e a n i n g s would have  "mink", and  Bower's  Nodes t h a t  is strongly associated  (e.g.,  of t h e  representation  of the  number and  nodes, a l o n g  with  of t h e a s s o c i a t i o n s , a r e d e t e r m i n e d by t h e  of p r e v i o u s  e p i s o d e s and  these episodes.  b e t w e e n " s o f t " and a fisherman. representation  t h e experiences a s s o c i a t e d  Thus, the  strength  of t h e  "mink" i s s t r o n g e r  A l s o , the  the the  number with  association  for a f u r r i e r  c o n c e p t "snow" w o u l d have  f o r an E s k i m o t h a n f o r a H a w a i i a n .  than f o r greater  13  Bower a l s o proposed that d i s t i n c t emotions such as lioy, fear,  and depression have t h e i r own nodes i n memory.  If  d e p r e s s i o n i s represented by m u l t i p l e nodes with s t r o n g associations,  s i m i l a r experiences  more l i k e l y to correspond  i n the future would be  to a c r i t i c a l  internal  r e p r e s e n t a t i o n and t r i g g e r a c t i v a t i o n of the d e p r e s s i o n node,  once the d e p r e s s i o n node i s a c t i v a t e d ,  s i m i l a r experiences would a l s o be a c t i v a t e d .  associated I f the  a s s o c i a t i o n s of these experiences are of s u f f i c i e n t s t r e n g t h , these experiences have the propensity to enter consciousness, b r i n g i n g along t h e i r a s s o c i a t e d f e e l i n g s of hopelessness The  and worthlessness.  network model i m p l i e s t h a t v u l n e r a b i l i t y to  d e p r e s s i o n i s r e l a t e d to previous experiences of d e p r e s s i o n . The  more extensive the r e p r e s e n t a t i o n of depression  (i.e.,  the g r e a t e r the number of nodes d i r e c t l y connected to the d e p r e s s i o n node), the g r e a t e r the l i k e l i h o o d of a c t i v a t i o n by s i m i l a r experiences, along with the greater a c c e s s i b i l i t y to s i m i l a r experiences and t h e i r a s s o c i a t e d f e e l i n g s .  This  n o t i o n i s c o n s i s t e n t with r e s e a r c h that personal c o n s t r u c t s become more organized or i n t e r r e l a t e d , and thus more v e r i f i a b l e , with p e r s i s t e n t usage (Bargh, Bond, Lombardi, & Tota, 1986; Davis & Unruh, 1981; Higgins, King, & Mavin, 1982), and with c l i n i c a l r e p o r t s t h a t the more e x t e n s i v e the ^experience with d e p r e s s i o n  ( i . e . , the greater the number of  previous episodes of d e p r e s s i o n ) , the greater the l i k e l i h o o d of r e l a p s e (Angst et a l . , 1973).  14 Depressive and  schemata provide  the b a s i s f o r p e r c e i v i n g  i n t e r p r e t i n g incoming environmental s t i m u l i  manner t h a t the f i n a l content  i n t e r p r e t a t i o n i s c o n s i s t e n t with the  of the schemata.  environmental s t i m u l i schematic processes  In t h e i r d r i v e to construe the  i n t o schema-congruent  information,  can produce such c o g n i t i v e phenomena as  memorial i n a c c u r a c i e s .  Alba and Hasher  summarized the four operations schemata achieve  i n such a  this:  (1983) have  by which the d e p r e s s i v e  s e l e c t i o n of which aspects  incoming information are to be processed  of the  further,  a b s t r a c t i o n of the meaning of the information, i n t e r p r e t a t i o n which may, i f necessary,  enhance or a l t e r the  i n f o r m a t i o n to be c o n s i s t e n t with the e x i s t i n g knowledge s t r u c t u r e , or to f i l l the  i n missing d e t a i l s , and i n t e g r a t i o n of  i n t e r p r e t e d information i n t o e x i s t i n g knowledge  structures.  Seen from the network p e r s p e c t i v e , mood may  serve as a c o n t e x t u a l cue, p r e f e r e n t i a l l y a c t i v a t i n g associations state.  i n the network t h a t are congruent with the mood  Schematic processing should  be evident as a t t e n t i v e  and memorial biases for d e p r e s s i o n - r e l a t e d s t i m u l i , with t h e i r a s s o c i a t e d c o g n i t i v e products thoughts).  (i.e.,  C l a s s i f i e d d i f f e r e n t l y , schemata  along  depressive  processing  encumbers both automatic ( s e l e c t i o n and a b s t r a c t i o n ) and effortful  ( i n t e r p r e t a t i o n and I n t e g r a t i o n )  (Hasher & zacks, relevance  processing  19 79; S c h l f f r i n & Schneider,  19 7 7 ) .  of t h i s c l a s s i f i c a t i o n w i l l be explained  The  later.  15  As  discussed earlier,  individuals  d e p r e s s i v e schemata  to depression.  However, t h e p r e c i s e  which t h i s  occurs  depressive  s e l f - s c h e m a t a have a t r a i t l i k e  [Tlhese  is controversial.  behavioral cognitive  emphasis  patterns that  responses dimension  individual's  used  as  of t h e  the  one  manner i n hand,  quality:  identifiable  Influence attitude t h e y may  constitute  and a  depression-prone  (Kovacs  & Beck, 1978,  p.  525,  mine).  cognitive an  [and]  personality  Thus, B e c k ' s m a l a d a p t i v e enduring  On  schemas a r e l o n g - t e r m ,  psychological  predispose  self-referent  characteristics  indicator  schemata are  that  can  be  who  are  prone  of i n d i v i d u a l s  seen  measured  as and  to  d e p r e s s i on. But  another  Initiated  exists.  account  Depressive  structures  which remain  particular  conditions:  These can  be  of how  activated  schemata are  latent  negative concepts  a depressive episode  until  cognitive  r e v e a l e d under  (schemas) may  by s p e c i f i c  be  latent  circumstances  analogous  t o the e x p e r i e n c e s  embedding  the n e g a t i v e a t t i t u d e s  Initially (Beck  which  but are  responsible for e t a l . , 1979,  16) . Hence, s c h e m a t a a r e o n l y r e v e a l e d d u r i n g a d e p r e s s i v e episode.  is  p.  16 Teasdale'g  differential  colleagues,  a c t i v a t i o n theory.  and  his  why  i n d i v i d u a l s become d e p r e s s e d  Teasdale,  Teasdale  depression  circumstances.  However, the  recovery.  on  to  have d e p r e s s i o n  to  warrant  but  of  critical.  why on  to  of  according  activated  adverse of  s e v e r i t y and depression.  The  critical  become persistent  persistent  in patterns  Individual  go  chronicity  to Teasdale's d i f f e r e n t i a l  once the  fairly  t h o s e who  t o have s e v e r e and  to d i f f e r e n c e s  of  To  i s that  individuals  Beck  question  i n d i v i d u a l s are  diagnosis i s not  the  course  sufficient  some go  is related  are  not  V u l n e r a b i l i t y t o s e v e r e and  depression,  that  why  usual  vulnerable  therefore,  depression.  theory,  The  a clinical  depressed,  as  i s a normal r e a c t i o n  rapid  question,  (1988) v i e w e d  Unlike  activation  of  thinking  i s i n the  depressed  state. Vulnerable characterized aversive of  stimuli  as  and  thinking  those  can  of  interpreted.  be  The joint of  the  externally  e v e n t s , or  representations  Activation  ruminations r e l a t e d experiences  (Teasdale,  activated  stressful  the  to  (Fennell,  theorized,  i n t e r p r e t i n g e v e n t s as  uncontrollable  s u c h as  activation  i n d i v i d u a l s , Teasdale  of  information  the  be  further  current  or  past  Teasdale, Jones,  n a t u r e of the  pattern  environmental  i n memory of  could  processing  This  internally  tendency towards d e p r e s s o g e n i c  function  highly  1985). by  are  by events  fuelled  so  by  depressing & Damle,  1987).  interpretations  e x p e r i e n c e and  system t h a t  the  interprets  Is  a  state  them.  17 The  l a t t e r aspect  levels:  Influences Information p r o c e s s i n g on two  the type of i n f o r m a t i o n t h a t i s s e l e c t e d f o r  a t t e n t i o n , and which i n t e r p r e t a t i v e c a t e g o r i e s are h i g h l y primed  and, thus, are most l i k e l y t o be used  to interpret  experience.  These are s i m i l a r to schematic  Furthermore,  the type of i n f o r m a t i o n t h a t i s processed  be a f u n c t i o n of both what i s a v a i l a b l e i s most a c c e s s i b l e at a given time. nonvulnerable  operations. will  i n memory and what  For example, i n  i n d i v i d u a l s , what becomes a c c e s s i b l e are  r e l a t i v e l y mild negative s e l f - d e s c r i p t o r s such as " t h o u g h t l e s s " , " i n c o n s i d e r a t e " , and "rude".  In v u l n e r a b l e  i n d i v i d u a l s , a more g l o b a l negative view of s e l f becomes a c c e s s i b l e with such g l o b a l l y negative  descriptors,  i n c l u d i n g l a b e l such as "worthless", "no good", and "pathetic". Teasdale argues  that once t h i s system of depressogenic  c o g n i t i v e p r o c e s s i n g biases becomes a c t i v a t e d , the negative thoughts  themselves  d i s t u r b e d mood.  tend to exacerbate  and prolong the  Nolen-Hoeksema and her c o l l e a g u e s (Morrow &  Nolen-Hoeksema, 1990; Nolen-Hoeksema, 1987) o u t l i n e d three ways In which negative c o g n i t i o n s could a m p l i f y and prolong a depressed  mood.  F i r s t of a l l ,  behind t h e i r depressed  mood, depressed  v i r t u e of t h e i r depressed negative I n f e r e n c e s .  i n search f o r the reasons i n d i v i d u a l s (by  mood) are more l i k e l y to make  Second, ruminations over  d e p r e s s i o n can enhance the e f f e c t of e x i s t i n g  their maladaptive  c o g n i t i o n s by b r i n g i n g these c o g n i t i o n s t o the i n d i v i d u a l ' s  18 mind more o f t e n . coping the  by  F i n a l l y , ruminations can undermine a c t i v e  i n t e r f e r i n g with the a t t e n t i o n , c o n c e n t r a t i o n ,  i n i t i a t i o n of instrumental  i n a t t e n t i v e n e s s and  behavior.  results  negative  to warrant a c l i n i c a l At f i r s t  versus  glance,  of s u f f i c i e n t  eventually  i n t e n s i t y and  duration  the two The  accounts of v u l n e r a b i l i t y  may  c e n t r a l d i f f e r e n c e between  locus of the v u l n e r a b i l i t y , that Is, onset  maintenance.  However, Teasdale's way  about what c h a r a c t e r i z e s v u l n e r a b l e Beck's  thereby  diagnosis.  appear q u i t e d i f f e r e n t . them i s the  failures  This v i c i o u s c y c l e of  c o g n i t i o n , depression  in a depression  lead to  sense of h e l p l e s s n e s s ,  c o n t r i b u t i n g to the d e p r e s s i o n . depression,  The  b e h a v i o r a l d e f i c i t s may  which lead to a greater  and  of t h i n k i n g  i n d i v i d u a l s i s a k i n to  c o n c e p t u a l i z a t i o n of schema o p e r a t i o n s .  Indeed,  one  of the s t u d i e s v a l i d a t i n g Teasdale's d i f f e r e n t i a l a c t i v a t i o n theory used schematic measures (Dent & Teasdale,  1988).  T h e o r e t i c a l p r e d i c t i o n s from schema theory. previous  s e c t i o n , two  schemata predispose  v e r s i o n s were presented  vulnerable  In the  on  i n d i v i d u a l s to  These lead to d i f f e r e n t p r e d i c t i o n s supportive  how  depression. of  the  c o n s t r u c t v a l i d i t y of c o g n i t i v e v u l n e r a b i l i t y .  To  r e i t e r a t e , the  self-  first  v e r s i o n i s that depressive  schemata have a t r a i t l i k e c h a r a c t e r i s t i c 1978).. Thus, schemata are observable depressive  episode and  briefly  (Kovacs & Beck,  independent of a  are markers for those prone to  19 depression. viewpoint  T h e o r e t i c a l p r e d i c t i o n s c o n s i s t e n t with  are:  (a) Depressive  schemata are not only evident d u r i n g a  d e p r e s s i v e episode,  but a l s o p r i o r to and  from a depressive episode. evident even i n recovered (b)  this  a f t e r the  recovery  Thus, d e p r e s s i v e schemata are depressives.  Measures of d e p r e s s i v e schemata are r e l a t e d to and  p r e d i c t i v e of the l i k e l i h o o d of developing episode The  a depressive  i n some time i n the f u t u r e . second viewpoint  latent u n t i l  "switched  Teasdale,  i s t h a t d e p r e s s i v e schemata are  on" by a d e p r e s s i v e episode  al.,  1979;  (c)  Measures of the d e p r e s s i v e schemata are p r e d i c t i v e of  the s e v e r i t y and  1988).  (Beck et  Thus,  c h r o n i c i t y of a d e p r e s s i v e  episode.  An a d d i t i o n a l p r e d i c t i o n i s : (d)  The  s t r e n g t h of the depressive schemata Is r e l a t e d  the number of previous episodes  of d e p r e s s i o n  to  ( C o r o l l a r y of  Bower's [1982] model). Methodological In t h i s s e c t i o n , I review  Issues  the v a r i o u s  research  s t r a t e g i e s that have been used to examine c o g n i t i v e vulnerability.  The  advantages and disadvantages  of each  s t r a t e g y are o u t l i n e d . In d i s c u s s i n g t h e o r i e s of v u l n e r a b i l i t y , s e v e r a l researchers  (Depue & Monroe, 1986;  T e r i , & Hautzinger,  1985;  Lewlnsohn, Hoberman,  Monroe & S t e i n e r , 1986)  have  argued f o r the n e c e s s i t y of d i s t i n g u i s h i n g f a c t o r s r e l a t e d  to  the o n s e t  of a d e p r e s s i v e e p i s o d e and  determine  the c h r o n i c i t y  episode.  Some have even a r g u e d  needed  severity  f o r t h e s t u d y of how  a disorder  i s maintained  Monroe & s t e i n e r , the c o g n i t i v e  address The  bulk  attempted  onset  onset  that  that  strategies,  of d i r e c t n e s s  in testing  The  strategy  Involves following  depressed 1985;  over  individuals  ensure  1986; that  screening  along t h i s  persists  line  i n the  degree  to d i r e c t l y  address  of  of time  & Murrell,  Initially  nondepressed  to o b t a i n a subgroup of  1986).  premorbid  1981; need  sample by a  careful  functioning  i n d i v i d u a l s who  Mayol,  Researchers  p r e v a l e n c e of p s y c h i a t r i c  Measures o f p r e m o r b i d  between t h o s e  the  I t i s a p r o s p e c t i v e approach  ( e . g . , Hammen, Marks, deMayo, &  of l i f e t i m e  has  vulnerability.  a group  t h e y have a t r u l y  subject.  compared  Phifer  has  in this  t o , and  differing  i s designed  a course  research  Lewlnsohn, steinmetz, L a r s e n , & F r a n k l i n ,  O'Hara,  each  onset  of onset v u l n e r a b i l i t y .  individuals  Into  which  Implicit  i s evident prior  each  that  those  in  d e p r e s s i v e schemata have a  taken  issue  1986;  be d i v i d e d  and  vulnerability.  Research  first  can  vulnerability  beyond a d e p r e s s i v e e p i s o d e . of f o u r  how  to p e r s i s t i n g depression.  characteristic  one  are  and  (Depue & Monroe,  vulnerability  of r e s e a r c h i s the v i e w  stable  is initiated  literature  of t h e c o g n i t i v e  to address  models  Likewise, research strategies  vulnerability  vulnerability  that d i f f e r e n t  time  that  of a d e p r e s s i v e  a disorder  over  1986).  those which address  line  and  factors  to  diagnoses are  in  then  become d e p r e s s e d  with  21 those who  remain nondepressed.  d i f f e r e n c e s between these two  I t i s argued t h a t groups i n the premorbid  v a r i a b l e s become l i k e l y c a n d i d a t e s factors.  The  for onset  great advantage of t h i s design  vulnerability i s t h a t the  premorbid s t a t u s can be determined p r i o r to a d e p r e s s i v e episode. error.  However, t h i s d e s i g n may Researchers  be s u b j e c t to  have g e n e r a l l y administered  up d e p r e s s i o n measures at one  p o i n t i n time..  r e s e a r c h e r s assumed that i n d i v i d u a l s who follow-up are nonvulnerable i n d i v i d u a l s may  individuals.  become depressed  the follow-up date, or they may episode  but have recoved  the f o l l o w -  These  are nondepressed at However, these  at some future time beyond have had a d e p r e s s i v e  d u r i n g the time between i n i t i a l  follow-up,  sampling  assessment  p r i o r to follow-up  and  time.  Furthermore, the p r a c t i c a l c o n s t r a i n t s of the l a r g e sample s i z e and  the long time l a g r e q u i r e d to ensure an adequate  f i n a l sample of depressed  s u b j e c t s , along with the enormous  c o s t , c o n t r i b u t e to the s c a r c i t y of research of t h i s The  second research s t r a t e g y addresses  type.  onset  v u l n e r a b i l i t y i n d i r e c t l y by e s t a b l i s h i n g the s t a b i l i t y of depressive cognitions.  In g e n e r a l , researchers using  s t r a t e g y have assessed  i n d i v i d u a l s during a depressive  episode  and  Shaw, 1987).  r e t e s t e d them upon recovery In demonstrating  (e.g., Dobson &  t h a t depressive c o g n i t i o n s  remain s t a b l e with the a l l e v i a t i o n of d e p r e s s i o n , r e s e a r c h e r s argued that these  this  these  c o g n i t i o n s are not merely  symptoms of a depressive episode.  Their  traitlike  22 c h a r a c t e r i s t i c s have g e n e r a l l y been taken as evidence t h e i r s t a t u s as marker of v u l n e r a b i l i t y . however, presents an ambiguity It  of  This s t r a t e g y ,  i n i n t e r p r e t i n g the  results.  Is impossible to determine whether the c o g n i t i v e  v a r i a b l e s were present p r i o r to the d e p r e s s i v e episode hence, are candidates  for onset v u l n e r a b i l i t y f a c t o r s , or  become present by v i r t u e of having experienced episode  a depressive  and as such, are consequences or " s c a r s " (Lewlnsohn  et a l . , 1981) time  of a d e p r e s s i v e episode.  of measurement may  be c r i t i c a l .  In a d d i t i o n , the Should  a researcher  measure j u s t upon recovery or wait some time a f t e r The  and,  former approach may  result  recovery?  in misleading conclusions  because i t i s p o s s i b l e that there i s a desynchrony of d e p r e s s i v e symptoms, analogous to the desynchrony of symptoms with the a l l e v i a t i o n of fear (Lang, 1977, That  i s , there may  1979).  be a d i f f e r e n c e i n the rate of change  among the symptoms of d e p r e s s i o n , with the c o g n i t i v e aspects being among the slowest to show change. The  t h i r d s t r a t e g y t h a t addresses  Is a v a r i a n t of the second s t r a t e g y ,  onset  vulnerability  i n s t e a d of a  l o n g i t u d i n a l design, t h i s s t r a t e g y e n t a i l s a between-groups comparison between recovered depressed nondepressed c o n t r o l s .  individuals  Assuming t h a t depressive schemata  are s t a b l e markers of v u l n e r a b i l i t y , recovered (who  have expressed  experienced  with  t h e i r v u l n e r a b i l i t y by  a depressive episode)  depresslves  having  should show scores  on  measures of depressive schemata s i m i l a r to that of c u r r e n t l y  23 depressed previous  individuals. design,  this  For the same reasons as  design  cannot d i r e c t l y  for the  address  the  issue of onset v u l n e r a b i l i t y . The  fourth strategy  vulnerability  i n v o l v e s reframing  issue i n t o one  of p r e d i c t i v e v a l i d i t y .  based on the premise that d e p r e s s i v e v u l n e r a b i l i t y markers, should Investigators  the It i s  schemata, as  be p r e d i c t i v e of  relapse.  using t h i s s t r a t e g y t y p i c a l l y s e l e c t  vho  have j u s t been s u c c e s s f u l l y t r e a t e d  and  based on t h e i r c o g n i t i v e s t a t u s at t h a t time, p r e d i c t  the  l i k e l i h o o d of r e l a p s e at some f u t u r e p o i n t of time  (e.g., Levine,  Hollon,  Evan, & DeRubeis, 1988;  & Wetzel, 1 9 8 6 ) .  i t s external v a l i d i t y .  One  for their  subjects depression  Simon, Murphy,  advantage of t h i s design  That i s , one  of the d e f i n i t i o n s of  v u l n e r a b i l i t y i s a p r e d i s p o s i t i o n towards depression. the  p r e d i c t i o n of r e l a p s e  of v u l n e r a b i l i t y ,  one  disadvantage i n t h i s s t r a t e g y  predicts relapse  posttreatment c o g n i t i v e measures. measures may  Thus,  i s a r e l a t i v e l y d i r e c t assessment  p o t e n t i a l confound with poor response to treatment. type of research  is  is i t s This  on the b a s i s of However, the  cognitive  be r e f l e c t i v e of poor or Incomplete response to  treatment which, i n t u r n , may r e s i s t a n t type of  be r e f l e c t i v e  of a more  depression.  In each of these three  s t r a t e g i e s , demonstration of  s t a b i l i t y of the c o g n i t i v e v a r i a b l e i s not evidence of v u l n e r a b i l i t y .  necessarily  I t i s p o s s i b l e that these  v a r i a b l e s c o n s t i t u t e s t a b l e aspects of  vulnerable  the  I n d i v i d u a l s which have no impact on d e p r e s s i o n . c h a l l e n g e would s t i l l  remain i n demonstrating  The  how these  v a r i a b l e s c o n t r i b u t e to the onset, maintenance, and a l l e v i a t i o n of d e p r e s s i o n . s t r a t e g i e s can a l s o be c l a s s i f i e d address  i n t o those  v u l n e r a b i l i t y to p e r s i s t i n g d e p r e s s i o n .  question  which The c e n t r a l  i n r e s e a r c h using t h i s s t r a t e g y i s which v a r i a b l e s  determine the c h r o n i c i t y and s e v e r i t y of a depressive episode.  Research of t h i s nature  has assessed  the c o g n i t i v e  s t a t u s of s u b j e c t s who are i n i t i a l l y m i l d l y depressed and then, assessed  l e v e l s of depression a t some future time  (e.g., Dent & Teasdale,  1988).  Instead of asking which v a r i a b l e s a m p l i f y a depressive episode  as l n the previous research s t r a t e g y , some  r e s e a r c h e r s have examined which v a r i a b l e s serve as an impediment to recovery.  Such s t u d i e s have used c o g n i t i o n s  to p r e d i c t response or r e s i s t a n c e t o treatment Keller,  (e.g.,  1983).  i n summary, r e s e a r c h e r s have used a v a r i e t y of r e s e a r c h s t r a t e g i e s to address  cognitive v u l n e r a b i l i t y .  these s t r a t e g i e s can be c l a s s i f i e d  i n t o those which  onset v u l n e r a b i l i t y and those which address p e r s i s t i n g depression. presented  Although  i n the next chapter,  Generally, address  v u l n e r a b i l i t y to  the l i t e r a t u r e , review,  i s d i v i d e d along the l i n e s of  the methods used, a l l of the methods used the m a j o r i t y of these  strategies.  25  Chapter 3:  Review of the Research on  Cognitive  Vulnerability  Whereas the previous s e c t i o n has c a t e g o r i z e d the literature organized  in terms of r e s e a r c h s t r a t e g i e s , t h i s chapter i n terms of the measures used.  For the most p a r t ,  s t u d i e s addressing c o g n i t i v e v u l n e r a b i l i t y have used r e p o r t q u e s t i o n n a i r e s , memory measures, and response to c o g n i t i v e therapy and In reviewing were used.  self-  differential  pharmacotherapy.  the l i t e r a t u r e , two  First,  is  inclusion  criteria  i n order to provide a focus, only  those  measures t h e o r e t i c a l l y t i e d to Beck et a l . ' s (1979) model were Included.  Second, t h i s review  was  l i m i t e d to s t u d i e s  using samples defined by c l i n i c a l and/or research d i a g n o s i s such as DSM-III or Research D i a g n o s t i c C r i t e r i a , excluded  those  and  s t u d i e s using analogue samples such as  c o l l e g e students  c l a s s i f i e d as "depressed"  s o l e l y on  b a s i s of t h e i r scores on the Beck Depression  the  Inventory  (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). The Recently,  reason  for the second c r i t e r i o n  i s the f o l l o w i n g .  s e r i o u s r e s e r v a t i o n s have been r a i s e d on  the  g e n e r a l i z a b i l l t y and a p p l i c a b i l i t y of analogue s t u d i e s using m i l d l y dysphoric c o l l e g e students c l i n i c a l depression.  Coyne and  to the phenomenon of  G o t l i b (1983) and  Monroe (1978) d e t a i l e d the reasons  why  It i s unwise to  combine such analogue s t u d i e s with r e s e a r c h on p a t i e n t samples.  Depue and  depressed  Analogue samples are f u r t h e r removed from  the c o n s t r u c t of I n t e r e s t and,  thus, do not o f f e r the most  26 direct test.  Furthermore, the experimental  v a r i a b l e s may be  s p e c i f i c to u n i p o l a r d e p r e s s i o n and, thus, may not be present  i n analogue samples. Studies Using S e l f - R e p o r t  The  Questionnaires  bulk of the c o g n i t i v e v u l n e r a b i l i t y r e s e a r c h has  used s e l f - r e p o r t q u e s t i o n n a i r e s , perhaps because of t h e i r sheer and  ease of a d m i n i s t r a t i o n .  Since t h i s t h e s i s uses Beck  h i s c o l l e a g u e s ' c o g n i t i v e framework, i t w i l l  on those  q u e s t i o n n a i r e s e x p l i c i t l y developed  framework. (DAS;  These are:  focus  only  under that  the D y s f u n c t i o n a l A t t i t u d e Scale  Weissman, 1978), the Automatic Thoughts  Questionnaire  (ATQ'; Hollon & K e n d a l l , 1980), and the Hopelessness Scale (HS;  Beck, Weissman, L e s t e r , & T r e x l e r , 1974).  v  The DAS  purports to measure d y s f u n c t i o n a l a t t i t u d e s -- c o g n i t i o n s t h e o r e t i c a l l y seen as s t a b l e aspects  of v u l n e r a b l e  i n d i v i d u a l s , while the HS and the ATQ assess  automatic  thoughts - - c o g n i t i o n s seen as symptomatic of d e p r e s s i o n . Despite t h i s t h e o r e t i c a l d i s t i n c t i o n of t r a i t versus s t a t e a s p e c t s ^ o f d e p r e s s i v e c o g n i t i o n s , some r e s e a r c h e r s have t r e a t e d a l l three measures as equal candidates vulnerability factors. Blackburn's  For example, Wilkinson and  (1981) c e n t r a l question  [recovered d e p r e s s i v e s ] e x h i b i t t h i s their  illness  for cognitive  i s i n remission?"  l n t h e i r study was "Do [ c o g n i t i v e ] s t y l e when  (p. 284), and they  justified  the use of the HS as an a p p r o p r i a t e method of measurement s i n c e "tt.lo date  i t i s probably the best v a l i d a t e d measure  of c o g n i t i v e s t y l e "  (p. 284).  27 Studies Using the  DAS  Many I n v e s t i g a t i o n s have used the DAS v u l n e r a b i l i t y to d e p r e s s i o n ,  as an  index  s t u d i e s comparing DAS  taken d u r i n g a d e p r e s s i v e episode  scores  and at r e m i s s i o n  f o r the most p a r t , f a i l e d to support  of  have,  the n o t i o n of  d y s f u n c t i o n a l a t t i t u d e s as s t a b l e aspects of v u l n e r a b l e individuals. DAS  Most s t u d i e s of t h i s nature  have found  scores endorsed by r e m i t t e d depressed  comparable to those subjects  & Lumry, 1986; 1985;  1984).  Jones, & Lewin, 1987;  Dohr, Rush, &  Hamilton & Abramson, 1983;  Hollon, Kendall,  Reda, C a r p l n i e l l o , S e c c h i a r l l , &  Schrader,  Silverman,  i n d i v i d u a l s were  endorsed by nondepressed c o n t r o l  (Blackburn,  B e r n s t e i n , 1989;  Gibbs,  & Harcourt,  & E a r d l e y , 1984;  Only two  1986;  Blanco,  Silverman,  Simons, G a r f i e l d , & Murphy,  s t u d i e s have shown that DAS  r e m i t t e d depressed  that  scores from  p a t i e n t s were e l e v a t e d i n comparison to  nondepressed c o n t r o l s (Dobson & Shaw, 1986;  Eaves & Rush,  1986). The d i s c r e p a n c y  i n the r e s u l t s may  be accounted f o r by  the length of time of symptom r e m i s s i o n .  Unfortunately,  many of these s t u d i e s do not provide estimates of r e m i s s i o n . estimates,  But among the s t u d i e s p r o v i d i n g such  i t i s i n t e r e s t i n g that short periods of r e m i s s i o n  are a s s o c i a t e d with e l e v a t e d DAS 2-3  of d u r a t i o n  scores  (Eaves & Rush,  weeks), whereas longer periods are a s s o c i a t e d with  scores w i t h i n the normal range (Reda et a l . , 1985, Schrader  et a l . , 1986,  > 1 year; Silverman  1984, DAS  1 year;  et a l . , 1984,  > 1  28 month; Simons et a l . , 1984,  > 1 month).  p o s s i b i l i t y t h a t e l e v a t e d DAS  This r a i s e s  the  scores are only present i n  r e l a t i v e l y r e c e n t l y remitted p a t i e n t s . It would appear t h a t long-term  remitted i n d i v i d u a l s are  not c h a r a c t e r i z e d by o v e r a l l e l e v a t e d DAS closer  However,  i n s p e c t i o n on s p e c i f i c d y s f u n c t i o n a l a t t i t u d e s y i e l d s  more i l l u m i n a t i n g r e s u l t s .  Reda et a l . (1985) administered  a modified v e r s i o n of the DAS d i s c h a r g e , and at 1 year the recovered depressed differ  scores.  upon h o s p i t a l admission,  following discharge. group's o v e r a l l DAS  follow-up,  scores d i d not  s i g n i f i c a n t l y from the c o n t r o l group.  the DAS  At  at  However, 13 of  b e l i e f s d i s c r i m i n a t e d the recovered group from the  nondepressed group, even at 1 year  follov-up.  Furthermore,  f i v e of these b e l i e f s seemed to be very r e s i s t a n t to change: Patients persisted  i n endorsing these b e l i e f s , d e s p i t e t h e i r  nondepressed s t a t u s at 1 year  follow-up.  These b e l i e f s  r e l a t e d to a p e s s i m i s t i c outlook, a f e l t need f o r c o n t r o l over t h e i r s i t u a t i o n s and  f e e l i n g s , along with a r e l u c t a n c e  to seek help from o t h e r s , an overemphasis on o t h e r s ' judgments and  o p i n i o n s , and  the sense that they should have  the a b i l i t y to s o l v e t h e i r problems q u i c k l y , independently, and  easily. i n t r i g u i n g f i n d i n g s have a l s o come from the p r o s p e c t i v e  studies.  Rush, Welssenburger, and  Eaves (1986) attempted to  p r e d i c t the outcome of p a t i e n t s f o l l o w i n g t h e i r from d e p r e s s i o n .  At 6 months follow-up, the DAS  best p r e d i c t o r of d e p r e s s i o n s t a t u s (as assessed  remission was  the  by the  Hamilton  Rating Scale f o r Depression  and c l i n i c a l  e v a l u a t i o n s based on Research D i a g n o s t i c C r i t e r i a ) , accounting  f o r 25% of the v a r i a n c e .  Simons, Murphy, Levine, and Wetzel  In a s i m i l a r v e i n , (1986) found t h a t DAS  s c o r e s , along with s o c i a l adjustment, were p r e d i c t i v e of r e l a p s e a t 1 year  posttreatment.  Instead of p r e d i c t i n g r e l a p s e , Dent and Teasdale p r e d i c t e d the p e r s i s t e n c e of d e p r e s s i o n .  (1988)  Along with  other  c o g n i t i v e measures, the DAS was p r e d i c t i v e of d e p r e s s i v e symptoms (as assessed by the Beck Depression  Inventory and  Research D i a g n o s t i c C r i t e r i a d i a g n o s i s ) at 5 months f o l l o w up  i n a sample of untreated women from the community. F i n a l l y , d y s f u n c t i o n a l a t t i t u d e s may hinder the  a l l e v i a t i o n of d e p r e s s i o n . s u b j e c t s with higher  Keller  initial  a t t i t u d e s showed poorer  (1983) found  that  l e v e l s of d y s f u n c t i o n a l  response  to c o g n i t i v e therapy.  r e l a t i o n s h i p held even when pretreatment  depression  This  scores  were c o n t r o l l e d f o r . S t u d i e s Using the ATQ and HS The support  m a j o r i t y of the s t u d i e s using the ATQ and the HS the n o t i o n that automatic  of d e p r e s s i o n .  thoughts  are symptomatic  The m a j o r i t y of the s t u d i e s using recovered  d e p r e s s i v e s have found  that t h e i r scores obtained from the  ATQ and HS were comparable with those of the nondepressed c o n t r o l group (HS:  Dobson & Shaw, 1986; Hamilton &  Abramson, 1983; Wilkinson & Blackburn, al.,  1981.  ATQ;  Dohr et  1987; Eaves & Rush, 1984; H o l l o n , K e n d a l l , & Lumry,  30 1986),  (1986)  Furthermore, Rush, weissenburger, and Eaves  found t h a t A T Q scores were not p r e d i c t i v e of d e p r e s s i v e symptoms a t 6 months f o l l o w - u p . However, two s t u d i e s c o n t r a d i c t t h i s trend. Dobson and Shaw (1986)  found that r e m i t t e d depressed p a t i e n t s endorsed  a higher p r o p o r t i o n of automatic thoughts than the nondepressed (1987)  control subjects.  A d d i t i o n a l l y , Dohr et a l .  found that r e m i t t e d d e p r e s s i v e s endorsed more  hopelessness items than nondepressed  control subjects.  i s u n c l e a r whether the l a t t e r two s t u d i e s employed  It  patients  who had j u s t r e c e n t l y r e c o v e r e d . Are D A S , ATQ, and H S Responses S o l e l y Mood  Congruent?  So f a r , the m a j o r i t y of the s t u d i e s have shown t h a t r e m i t t e d scores on the D A S , ATQ, and H S are comparable t o those of nondepressed  controls.  This trend r a i s e s the  q u e s t i o n whether the s u b j e c t s endorse congruent with t h e i r mood s t a t e .  items that are  That i s , depressed  s u b j e c t s may be endorsing depressogenic items simply i n response t o t h e i r negative tone.  Three s t u d i e s suggest that  endorsement of negative items i s not e n t i r e l y a r e f l e c t i o n of depressed mood. approximately 1/2  Hamilton and Abramson (1983) found that of t h e i r depressed sample achieved scores  In the normal range on a number of c o g n i t i v e which  i n c l u d e d the D A S and H S .  mood, by i t s e l f , cognitive  style.  questionnaires,  T h i s suggests that depressed  i s not s u f f i c i e n t  to induce a d e p r e s s i v e  31 Robins, endorsed Simply  Block, and Peselow (1990) compared DAS scores  by endogeneous with non-endogenous d e p r e s s l v e s .  s t a t e d , endogenous depressions are assumed to be  p r i m a r i l y b i o l o g i c a l l y determined, d e p r e s s i o n s are assumed to occur  whereas non-endogenous i n r e a c t i o n to l i f e  s t r e s s o r s , e s p e c i a l l y i n i n d i v i d u a l s with c e r t a i n types of premorbid  p e r s o n a l i t y ( K l l o h & Garslde, 1 9 6 3 ) .  The l a t t e r  type Is assumed to be c h a r a c t e r i z e d by a depressive cognitive style.  Even though the endogenous d e p r e s s l v e s had  higher s c o r e s on measures of depression than the nonendogenous d e p r e s s l v e s , the l a t t e r had higher DAS s c o r e s , i n other words, there i s not an one-to-one between s e v e r i t y of depressed  correspondence  mood and DAS s c o r e s . (1988) assessed  F i n a l l y , Miranda and Person  performance  on the DAS f o l l o w i n g an i n d u c t i o n of sad mood using the V e l t e n technique reading aloud  (Velten, 1968).  This technique  involves  60 negative s e l f - r e f e r e n t statements.  endorsement of negative  If  items on s e l f - r e p o r t q u e s t i o n n a i r e s  are merely a mood congruency e f f e c t , then s u c c e s s f u l i n d u c t i o n of depressed endorsement r a t e .  mood would lead to a higher  Two groups of s u b j e c t s with no p r i o r  h i s t o r y of d e p r e s s i o n and those with a h i s t o r y of d e p r e s s i o n were both s u c c e s s f u l l y induced  i n t o a sad mood.  However,  only those s u b j e c t s with a previous h i s t o r y of depression endorsed  more d y s f u n c t i o n a l a t t i t u d e s f o l l o w i n g the mood  Induction.  32 Summary of DAS, ATQ, and HS S t u d i e s This c o l l e c t i o n of s t u d i e s suggest conclusions.  the f o l l o w i n g  Endorsement of d e p r e s s i v e c o g n i t i o n s  q u e s t i o n n a i r e s are probably not s o l e l y mood dependent.  The  c o g n i t i v e model i s not r e l i a b l y p r e d i c t i v e of which types of c o g n i t i o n s are t r a i t l i k e and which are symptomatic of depression.  A few s t u d i e s have found  negative  thoughts t o be e l e v a t e d i n r e m i t t e d depressed but the m a j o r i t y of s t u d i e s suggest normal l e v e l s hypothesized  i n remission.  automatic Individuals,  t h a t these r e t u r n to  Dysfunctional attitudes,  t o be s t a b l e a s p e c t s , may s t i l l  be evident f o r  newly r e m i t t e d p a t i e n t s , but may be a l t e r e d as the p a t i e n t continues these  to s t a y i n r e m i s s i o n .  Group-means comparison of  q u e s t i o n n a i r e responses g e n e r a l l y y i e l d e d  nonsupportlve  results,  on the other hand, the l o n g i t u d i n a l  study of r e m i t t e d depressed promising  s u b j e c t s provides much more  r e s u l t s , with d y s f u n c t i o n a l a t t i t u d e s r e l i a b l y  p r e d i c t i v e of future dysphoria and r e l a p s e . Studies Using Memory Measures In a previous s e c t i o n , I d i s c u s s the importance of self-schemata  i n depressive v u l n e r a b i l i t y .  Also as  d i s c u s s e d p r e v i o u s l y , the i n f l u e n c e of the depressive  self-  schemata i s made evident by memorial b i a s e s f o r d e p r e s s i o n related stimuli.  Thus, a reasonable  p o i n t of i n q u i r y f o r  v u l n e r a b i l i t y research would be In the memory s t u d i e s . Memory s t u d i e s , which address  v u l n e r a b i l i t y , can be d i v i d e d  i n t o two  groups:  task, and  those  those using the s e l f - r e f e r e n t using other  encoding  paradigms.  S e l f - R e f e r e n t Encoding Task Studies The  s e l f - r e f e r e n t encoding  designed  task  (SRET) was  specifically  to assess schemata ( c f . Markus, 1977).  i n the  SRET, s u b j e c t s t y p i c a l l y are asked to r a t e a l i s t a d j e c t i v e s as s e l f - d e s c r i p t i v e or not. d e p r e s s i v e self-schema, related  recorded. task  In the r e s e a r c h  r e s e a r c h e r s have used  (schema-congruent) and p o s i t i v e  adjectives.  SRET produces three  depression-  judgments are  F o l l o w i n g the judgment task, an The  on  (schema-lncongruent)  D e c i s i o n l a t e n c i e s for these  i s given.  of  incidental  recall  indexes:  endorsement r a t e for the a d j e c t i v e s , d e c i s i o n l a t e n c i e s for judgments, and  r e c a l l of a d j e c t i v e s .  t h a t i n d i v i d u a l s are:  Schema theory p r e d i c t s  (a) more l i k e l y to endorse schema-  congruent a d j e c t i v e s as s e l f - d e s c r i p t i v e , schema-related  (b)  process  items more e f f i c i e n t l y as r e f l e c t e d  s h o r t e r d e c i s i o n l a t e n c i e s , and  by  (C) r e c a l l a higher  p r o p o r t i o n of schema-congruent a d j e c t i v e s .  Endorsement  r a t e s should be symptomatic of d e p r e s s i o n , whereas the r e c a l l and  d e c i s i o n l a t e n c i e s indexes  for depression-related  s t i m u l i are t h e o r i z e d to be more s t a b l e aspects depression  (cf,. Myers, Lynch, & Bakal,  In the area of depression, Kuiper (Derry & Kuiper, the f i r s t  1981; Kuiper  of  1987). and  his colleagues  & MacDonald, 1983) were among  r e s e a r c h e r s to use the SRET to measure depressive  self-schema.  They found  that depressed  individuals  had  34 higher endorsement r a t e s , shorter d e c i s i o n l a t e n c i e s , enhanced r e c a l l  and  for depression-related a d j e c t i v e s .  Dobson and  Shaw (1987) attempted to assess  the  s t a b i l i t y of the d e p r e s s i v e schemata i n a l o n g i t u d i n a l design. first  Depressed p a t i e n t s were given the SRET twice.  t e s t i n g s e s s i o n was  episode.  A subset  was  conducted d u r i n g a depressive  of t h i s depressed  while they were s t i l l  depressed,  group were r e t e s t e d  whereas the other  r e t e s t e d upon symptom r e m i s s i o n .  remained depressed across the two  The  subjects  subset who  showed c o n s i s t e n t performance on the SRET  t e s t i n g occasions, demonstrating  at l e a s t  adequate t e s t - r e t e s t r e l i a b i l i t y of the SRET. i n v e s t i g a t o r s found remitted depressed  The  a shift patients.  However, the  in SRET performance i n the The  i n v e s t i g a t o r s concluded  that " [ t ] h e r e s u l t s of the present study must t e n t a t i v e l y be added to the number of s t u d i e s that have f a i l e d  to document  s t a b l e c o g n i t i v e p r o c e s s i n g in depressive episodes beyond" (p.  and  39).  However, Dobson and  Shaw's c o n c l u s i o n seems premature.  I t appears t h a t they were only able to p a r t l y demonstrate evidence  of d e p r e s s i v e schematic  processing.  were able to demonstrate that symptomatic endorsed more negative a d j e c t i v e s as  Although  they  depresslves  self-descriptive,  compared with the nondepressed c o n t r o l s , they were not able to demonstrate depressed-nondepressed group d i f f e r e n c e s i n e i t h e r d e c i s i o n l a t e n c i e s or in r e c a l l  f o r the  types of words.  although  I t i s not s u r p r i s i n g ,  different  35 t h e o r e t i c a l l y u n i n t e r e s t i n g , that the endorsement r a t e 3 changed as a f u n c t i o n of recovery.  More t h e o r e t i c a l l y  I n t e r e s t i n g measures a t t e s t i n g to the s t a b i l i t y of depressive  the  self-schema l i e In the d e c i s i o n l a t e n c i e s and  r e c a l l measures.  The  f a i l u r e to demonstrate depressed-  nondepressed group d i f f e r e n c e s on those measures s e r i o u s l y undermines the power of t h i s study i n i l l u m i n a t i n g the  issue  of v u l n e r a b i l i t y . Bradley  and  Mathews (1988) were able to demonstrate  memorial biases  using the SRET.  Their group of c u r r e n t l y  depressed p a t i e n t s showed the p r e d i c t e d negative for m a t e r i a l t h a t had themselves.  to  The  i n c l u d i n g a group of recovered recovered  group resembled the  depressed nondepressed  group i n f a v o r i n g p o s i t i v e s e l f - r e f e r e n t m a t e r i a l . an unexpected r e s u l t was 1988).  a l s o found  (as r e p o r t e d  C u r r e n t l y depressed p a t i e n t s who  i n the study because they had because they had a negative  self-referent r e c a l l bias. first,  included  manic episode or  Therapy —  This r a i s e s  the d e p r e s s i v e  be s p e c i f i c to u n i p o l a r depression,  underlying  i n Brewln,  were not  a previous  However,  undergone c o g n i t i v e therapy, f a i l e d to show  intriguing possibilities:  Cognitive  bias  They then t e s t e d the c o g n i t i v e v u l n e r a b i l i t y  hypothesis by patients.  been encoded i n r e l a t i o n  recall  and  changes i n the d e p r e s s i v e  may  self-schema.  schema  may  second, responses to  a therapy p u r p o r t i n g  dysfunctional beliefs —  two  to a l t e r  be r e f l e c t e d i n  36  Teasdale and Dent  (1987) compared the r e c a l l o£  recovered depressed with never depressed Although both groups  Individuals.  r e c a l l e d equal amounts of negative  m a t e r i a l , the recovered depressed subjects d i f f e r e d never depressed s u b j e c t s i n that they r e c a l l e d  from the  fewer  p o s i t i v e a d j e c t i v e s , s u g g e s t i n g reduced a c t i v a t i o n of p o s i t i v e aspects of the self-schema.  This d i f f e r e n c e held,  even when i n i t i a l d e p r e s s i o n l e v e l s were c o n t r o l l e d f o r . These i n v e s t i g a t o r s then went on to t e s t t h e i r  differential  a c t i v a t i o n hypothesis a c c o r d i n g to which, negative aspects of the self-schema become a c c e s s i b l e only when the vulnerable i n d i v i d u a l  Is i n a depressed mood.  a 3ad mood i n t h e i r two groups.  They  Induced  Under the induced sad mood,  the recovered depressed s u b j e c t s showed b e t t e r r e c a l l of s e l f - r e f e r e n t i a l negative a d j e c t i v e s than the never depressed  individuals.  Along s i m i l a r l i n e s , Dent and Teasdale  (1988) asked  whether measures of the d e p r e s s i v e self-schema would be r e l a t e d to the p e r s i s t e n c e of depressed mood.  Using  D i a g n o s t i c Research C r i t e r i a to i d e n t i f y a group of  ^  untreated depressed women from the community, these i n v e s t i g a t o r s c o r r e l a t e d self-schema measures with t h e i r d e p r e s s i o n measures a t 5 months follow-up.  At follow-up,  high d e p r e s s i o n s c o r e s were r e l a t e d to the endorsement rate and r e c a l l of n e g a t i v e but not p o s i t i v e terms.  T h i s study  provides p r e l i m i n a r y evidence that negative aspects of the  37  self-schema are i n s t r u m e n t a l i n the p e r s i s t e n c e of depression. Other Memory S t u d i e s Although not e x p l i c i t l y under the framework of schema theory, three s t u d i e s a d d r e s s i n g v u l n e r a b i l i t y used memory measures.  S l i f e , Miura, Thompson, Shapiro, and Gallagher  (1984) followed three groups of e l d e r l y d e p r e s s l v e s undergoing  b e h a v i o u r a l , c o g n i t i v e , and  treatments  for d e p r e s s i o n .  rated trigrams was  psychodynamlc  Patients' r e c a l l  of p l e a s a n t l y -  assessed on three o c c a s i o n s :  the i n i t i a t i o n of therapy, midway through, and termination.  p r i o r to after  P r i o r to the i n i t i a t i o n of therapy,  depressed  p a t i e n t s r e c a l l e d more trigrams that they r a t e d as d i s l i k e d than those they r a t e d as l i k e d ,  upon r e c o v e r y f o l l o w i n g  s u c c e s s f u l therapy, these p a t i e n t s r e c a l l e d more trigrams that they rated as l i k e d .  It is d i f f i c u l t  to determine  whether these r e s u l t s are supportive of c o g n i t i v e v u l n e r a b i l i t y theory. two  C o g n i t i v e therapy, but not the other  t h e r a p i e s , has t h e o r e t i c a l l y the p r o p e n s i t y to a l t e r  d e p r e s s i v e schemata, hence l e a d i n g to enhanced r e c a l l of the l i k e d trigrams as therapy progressed.  Whether t h i s outcome  occurred can not be assessed, however, because the I n v e s t i g a t o r s d i d not conduct  separate analyses on the  r e c a l l performance i n each treatment The other two results.  modality.  s t u d i e s have y i e l d e d  nonsupportive  In a l o n g i t u d i n a l design, Fogarty and Hemsley  (1983) asked s u b j e c t s to r e c a l l past r e a l l i f e  experiences  38 a s s o c i a t e d with a s e r i e s of stimulus words.  The depressed  p a t i e n t s , compared to the nondepressed s u b j e c t s , showed a g r e a t e r p r o b a b i l i t y of r e c a l l i n g sad memories. depressed  p a t i e n t s who showed c l i n i c a l  Among the  Improvement a t 6  weeks r e t e s t l n g , the p a t t e r n of r e c a l l had s h i f t e d .  They  had  a s i g n i f i c a n t r e d u c t i o n i n the r e c a l l of sad memories  and  an increased p r o b a b i l i t y of producing  happy memories.  i n a v a r i a t i o n of t h i s theme, Lewlnsohn and Rosenbaum (1987) examined whether the r e c a l l of c e r t a i n p a r e n t a l behavior  i s a s t a b l e c h a r a c t e r i s t i c of depressed  individuals.  Depressed i n d i v i d u a l s r e c a l l e d t h e i r  parents  as r e j e c t i n g and u n l o v i n g , compared to nondepressed controls.  The remitted d e p r e s s l v e s , however, d i d not d i f f e r  from the nondepressed c o n t r o l s i n t h e i r r e c a l l of p a r e n t a l behavior.  The i n v e s t i g a t o r s concluded  p a r e n t a l behavior  t h a t the r e c a l l of  was not a s t a b l e aspect  of d e p r e s s i o n .  Since t h i s study d i d not provide checks on a c t u a l p a r e n t a l behavior,  i t i s impossible to a s c e r t a i n whether memory  b i a s e s are at play here. summary of Findings from Memory Studies The  r e s u l t s of the memory s t u d i e s p a r a l l e l the r e s u l t s  from the q u e s t i o n n a i r e s t u d i e s . either  Between-groups comparisons,  l n a l o n g i t u d i n a l approach or In comparing  with c u r r e n t l y depressed results.  subjects, yielded  In terms of p r e d i c t i v e u t i l i t y ,  memory r e s e a r c h holds some promise.  recovered  nonsupportive however, the  39 Studies examining D i f f e r e n t i a l Relapse Rates Some of the s t r o n g e s t and  most c o n s i s t e n t evidence  c o g n i t i v e v u l n e r a b i l i t y comes from the r e l a p s e Simons, Murphy, Levine, and  Wetzel  depression.  In support  literature.  (1986) followed  p a t i e n t s 1 year a f t e r s u c c e s s f u l treatment  of  depressed  of t h e i r  of the v u l n e r a b i l i t y model,  c o g n i t i v e f a c t o r s were p r e d i c t i v e of the p r o b a b i l i t y of relapse.  P a t i e n t s who  scores at treatment had  termination.  s i g n i f i c a n t l y higher  Furthermore, p a t i e n t s  r e c e i v e d C o g n i t i v e Therapy, with or without  drug treatment, who  r e l a p s e d had  had  who  combined  were l e s s l i k e l y to r e l a p s e than p a t i e n t s  r e c e i v e d pharmacotherapy alone.  has been r e p l i c a t e d by at l e a s t two studies  DAS  The  other  (Blackburn, Eunson, & Bishop,  latter  finding  Independent  1986;  H o l l o n , Evans, &  DeRubels, 19 88). Summary of status of C o g n i t i v e V u l n e r a b i l i t y Research Despite the methodological some of the s t u d i e s , two f a c t o r i a l designs  d i f f i c u l t i e s a s s o c i a t e d with  trends emerge,  s t u d i e s using  (e.g., comparing scores d u r i n g a  d e p r e s s i v e episode and c u r r e n t l y depressed  and  upon recovery, comparing groups of recovered  i n g e n e r a l , y i e l d e d nonsupportive  depressed  s u b j e c t s ) have,  results.  However, s t u d i e s  concerned with p r e d i c t i o n ( p r e d i c t i n g course response to treatment,  p r o b a b i l i t y of r e l a p s e ) have y i e l d e d  c o n s i s t e n t l y supportive f i n d i n g s . may  of d e p r e s s i o n ,  The apparent  discrepancy  l i e i n d i f f e r e n t i a l s t a t i s t i c a l power a s s o c i a t e d with  each d e s i g n .  The  f a c t o r i a l d e s i g n s , used i n these s t u d i e s ,  have g e n e r a l l y involved betveen-groups analyses,  whereas the  c o r r e l a t i o n a l - b a s e d designs used i n the p r e d i c t i o n s t u d i e s i n v o l v e d within-group analyses. t y p i c a l l y more powerful.  The l a t t e r analyses are  Given the trends  l n the l i t e r a t u r e  review, i t seems that only weak support i s found f o r cognitive vulnerability factors. P o t e n t i a l Confounds l n the C o g n i t i v e V u l n e r a b i l i t y measures As d i s c u s s e d provides,  p r e v i o u s l y , the l i t e r a t u r e review  a t best, weak and sometimes i n c o n s i s t e n t support  for c o g n i t i o n s as v u l n e r a b i l i t y f a c t o r s .  In t h i s s e c t i o n , I  argue t h a t the measures used i n the l i t e r a t u r e are by nature r e a c t i v e t o a l l e v i a t i o n of depressed mood, and thus are not appropriate Segal  measures of c o g n i t i v e v u l n e r a b i l i t y . (1988) has o u t l i n e d a number of confounds i n the  measures used In the l i t e r a t u r e . of the endorsement of negative  He questioned the u t i l i t y  s e l f - d e s c r i p t o r s In the study  of v u l n e r a b i l i t y f a c t o r s as those measures are o f t e n mood l a b e l s and a c c o r d i n g l y ,  are r e a c t i v e to the a l l e v i a t i o n of  depressed mood,  furthermore, i n d i c a t e d that the SRET  Segal,  was i n f l u e n c e d by s u b j e c t s ' response s t y l e f a c t o r s such as social desirability. Carlson  For example, Ferguson, Rule, and  (1983) showed that under the SRET, memory f o r  d e s i r a b i l i t y - r a t e d a d j e c t i v e s was a t l e a s t as good as f o r self-rated adjectives. S i m i l a r l y , other  researchers  p o s s i b i l i t y that depressive  have r a i s e d the  memorial biases are a t t r i b u t a b l e  41 to r e s p o n s e b i a s e s . depressed  M i l l e r and  i n d i v i d u a l s may  memory but  Levis  (1977) proposed that-  have the c o r r e c t answers s t o r e d  because of an o v e r l y c a u t i o u s  response s t y l e ,  u n w i l l i n g to report them to the experimenter. s i g n a l d e t e c t i o n procedures on depressed and p a t i e n t s along  with normal c o n t r o l s .  the computation of d' criterion).  demented  T h i s procedure allowed ^(decision  Depressed s u b j e c t s d i d not d i f f e r suggesting  from  the  that the memory f u n c t i o n s  of depressed s u b j e c t s were as e f f i c i e n t as those of normal c o n t r o l s .  However, d e p r e s s l v e s  more c o n s e r v a t i v e  response s t r a t e g y , as evident  criterion.  Dunbar and  conservative of recognized  by  a  the  Lishman (1984) r e f i n e d t h i s  p o s i t i v e words.  the  These I n v e s t i g a t o r s  h o s p i t a l i z e d depressed with normal c o n t r o l s on  Although the two  the  were found to use  response s t y l e as a b i a s a g a i n s t  of words with high  are  They a p p l i e d  ( d i s c r l m i n a b i l i t y ) and  normal c o n t r o l s i n d',  in  (good) or low  (bad)  groups d i d not d i f f e r  reporting compared  recognition  hedonic tone. in recognition v.  performance, depressed s u b j e c t s appeared to adopt a more s t r i n g e n t c r i t e r i o n for p o s i t i v e words, i n d i c a t i n g a b i a s against  recognizing  why strategy?  p o s i t i v e words.  do depressed i n d i v i d u a l s adopt t h i s Johnson and  conservative  conservative  Magaro (1987) proposed that  response bias  i s a r e f l e c t i o n of the  this pathology.  They argued that depressed i n d i v i d u a l s are r e l u c t a n t to d i s p l a y t h e i r l e v e l of confusion depressed s t a t e , and  which i s inherent  so they adopt a c o n s e r v a t i v e  in their s t y l e and  respond  o n l y when they are r e a l l y sure,  Colussy, and Wieglo who  similarly,  zuroff,  (1983) t h e o r i z e d that depressed s u b j e c t s  were u n c e r t a i n whether they s e l e c t e d a negative  a d j e c t i v e as s e l f - d e s c r i p t i v e are responding to the hedonic tone of the s t i m u l i , and thus are more l i k e l y than nondepressed  s u b j e c t s to guess that they d i d .  If the  memorial b i a s e s d i s p l a y e d by d e p r e s s l v e s are r e f l e c t i v e of a response s t y l e , and  i f that response s t y l e  t h e i r depressed s t a t e  i s a r e s u l t of  (as suggested by Johnson  then memorial b i a s e s may  and Magaro),  be expected to be r e v e r s i b l e with  the a l l e v i a t i o n of d e p r e s s i o n . If s e l f - r e p o r t and memory measures used so f a r i n the c o g n i t i v e v u l n e r a b i l i t y l i t e r a t u r e are by t h e i r nature mood r e a c t i v e , then the next q u e s t i o n i s what measures are resilient  to mood changes and hence, are more s u i t a b l e f o r  the i n v e s t i g a t i o n of c o g n i t i v e v u l n e r a b i l i t y f a c t o r s .  As  the next chapter shows, some i n v e s t i g a t o r s have proposed that the key l i e s  i n automatic c o g n i t i v e processes.  43 chapter 4:  Automatic  Processes as  V u l n e r a b i l i t y Markers In t h i s chapter, I argue that d e p r e s s i v e  automatic  processes are v i a b l e candidates f o r v u l n e r a b i l i t y markers. F i r s t , automatic  and e f f o r t f u l processes are d e f i n e d .  Then  a p p l i c a t i o n of t h i s d i s t i n c t i o n to d e p r e s s i o n i s d i s c u s s e d . Next, a l i t e r a t u r e review of s t u d i e s on automatic  processes  In d e p r e s s i o n i s provided. D e f i n i t i o n s of Automatic  and E f f o r t f u l  Processes  Some r e s e a r c h e r s have c l a s s i f i e d c o g n i t i v e processes as automatic  or e f f o r t f u l  (Schneider & S c h i f f r l n , Snyder, 1975).  (Hasher  & Zacks,  1979), or s t r a t e g i c  1977), or conscious  (Posner &  These researchers have assumed a c a p a c i t y  model of a t t e n t i o n  (Kahneman, 1975).  The c a p a c i t y model  assumes t h a t there i s a general l i m i t on the energy available  f o r performing mental o p e r a t i o n s .  c a p a c i t y can be a l l o c a t e d  That l i m i t or  f l e x i b l y to d i f f e r e n t stages of  p r o c e s s i n g and to d i f f e r e n t p r o c e s s i n g a c t i v i t i e s . operations d i f f e r require.  Mental  i n the amount of a t t e n t i o n c a p a c i t y they  Concurrent  mental o p e r a t i o n s can compete f o r the  amount of c a p a c i t y so that one task i n t e r f e r e s with the other.  For example, i t i s very d i f f i c u l t  to perform  mental  a r i t h m e t i c while c a r r y i n g on a c o n v e r s a t i o n . Various t h e o r i e s d i f f e r somewhat In t h e i r d e f i n i t i o n of automatic  and e f f o r t f u l p r o c e s s i n g but common to these  t h e o r i e s are the f o l l o w i n g c r i t e r i a . are those t h a t operate without  Automatic  processes  I n t e n t i o n , without  44  n e c e s s a r i l y g i v i n g r i s e to awareness, and use no or minimal c a p a c i t y so as not to i n t e r f e r e with concurrent requiring capacity  (Posner & Snyder, 1975).  tasks  In c o n t r a s t ,  e f f o r t f u l operations  require considerable  i n t e r f e r e with other  cognitive a c t i v i t i e s requiring  c a p a c i t y ) , are i n i t i a t e d from p r a c t i c e .  capacity  (and so  i n t e n t i o n a l l y , and show b e n e f i t s  Classified differently, effortful  r e q u i r e a t t e n t i o n , while automatic p r o c e s s i n g  processes  i s processing  without a t t e n t i o n (Logan, 1988). Logan (1988) r e c e n t l y proposed t h a t resources  processing  p l a y no r o l e i n the a u t o m a t i c - e f f o r t f u l  distinction.  Rather, the d i s t i n c t i o n l i e s  a c q u i s i t i o n of knowledge.  That i s , novice  i n the (or s t r a t e g y -  c o n t r o l l e d ) performance i s l i m i t e d by a lack of knowledge. Automaticity,  Logan continues,  Information i n memory. considered  r e f l e c t s the build-up of  Performance, t h e r e f o r e , i s  automatic when r e t r i e v a l of r e l e v a n t  Information  i s based, on a s i n g l e , d i r e c t - a c c e s s step rather than on algorithmic  computation.  Some of the recent views are that automatic versus e f f o r t f u l processes are part of a continuum rather d i s c r e t e processes  than  (e.g., Cohen, Dunbar, & McCelland, 1990).  Using t h i s d e f i n i t i o n , s e l f - r e p o r t and memory tasks used i n the c o g n i t i v e v u l n e r a b i l i t y research  f a l l w i t h i n the  e f f o r t f u l end of the continuum s i n c e they are both o c c u r r i n g i n t e n t i o n a l l y and with awareness.  45  Automatic Processes  as P o t e n t i a l v u l n e r a b i l i t y Markers  According t o the c a p a c i t y model, the amount of c a p a c i t y a v a i l a b l e can v a r y depending on a number of f a c t o r s . Depression  i s among the v a r i a b l e s thought  to reduce the  t o t a l amount of a t t e n t l o n a l c a p a c i t y a v a i l a b l e f o r processing effortful  (Hasher & Zacks,  1979; Kahneman, 1 9 7 3 ) .  processes are capacity-demanding,  cause a d i s r u p t i o n to these processes, automatic  processes  Because  d e p r e s s i o n can  i n contrast,  should be u n a f f e c t e d by d e p r e s s i o n , as  these do not r e q u i r e or r e q u i r e minimal c a p a c i t y . For d i f f e r e n t reasons  from above, E l l i s  Thomas, & Rodrlgez,  and h i s  colleagues  (Ellis,  McFarland,  & Lane, 1985) s i m i l a r l y proposed t h a t d e p r e s s i o n  d i s r u p t s e f f o r t f u l but not automatic  1984; E l l i s ,  processes.  Thomas,  They  proposed that some c a p a c i t y i s t i e d up l n t h i n k i n g about one's d e p r e s s i o n , reducing the c a p a c i t y a v a i l a b l e that can be a l l o c a t e d to a given task. Summarizing, e f f o r t f u l but not automatic a f f e c t e d by depressed  mood.  tasks may be  As d i s c u s s e d p r e v i o u s l y ,  processes which are a f f e c t e d by the presence and a m e l i o r a t i o n of d e p r e s s i v e mood may be u n s u i t a b l e candidates for  v u l n e r a b i l i t y markers.  hypothesized  Since automatic  t o be unaffected by depressed  processes are mood, the  p o s s i b i l i t y e x i s t s that these processes are more s e n s i t i v e measures of v u l n e r a b i l i t y  factors.  As an a s i d e , a d i s t i n c t i o n i s made between  automatic  processes, d e s c r i b e d above, and Beck's c o n c e p t u a l i z a t i o n of  46 automatic thoughts.  What these concepts have i n common Is  that they occur without the i n d i v i d u a l ' s  intention.  However, automatic thoughts tend to be r e p e t i t i v e and intrude i n t o consciousness, whereas automatic processes occur outside of one's awareness.  Furthermore,  thoughts take up p r o c e s s i n g r e s o u r c e s .  I t i s common t h a t  depressed p a t i e n t s complain that they cannot aspects of t h e i r  l i v e s because  d e p r e s s i v e thoughts.  of t h e i r  automatic  focus on other  intrusive,  In c o n t r a s t , automatic p r o c e s s i n g  takes up minimal resources ( D a l g e i s h & Watts,  1990).  L i t e r a t u r e Review on Automatic and E f f o r t f u l Processes In Depression in t h i s s e c t i o n , I review the l i t e r a t u r e on automatic processes i n d e p r e s s i o n .  First,  I review the s t u d i e s which  show that d e p r e s s i o n a f f e c t s e f f o r t f u l and automatic tasks differentially.  A review of g e n e r a l automatic p r o c e s s i n g  studies i n depression follows.  Then, p a r t i c u l a r s t u d i e s on  automatic processes as v u l n e r a b i l i t y markers are o u t l i n e d . Although the previous l i t e r a t u r e review on c o g n i t i v e v u l n e r a b i l i t y excludes analogue Include such s t u d i e s because  s t u d i e s , t h i s s e c t i o n does  they sometimes use i n n o v a t i v e  measures that have not y e t been t r i e d with a c l i n i c a l l y depressed sample.  However, i t should be kept i n mind that  f i n d i n g s from these s t u d i e s may not be g e n e r a l l z a b l e t o a clinical  sample.  47 Differential  Effortful One  Effects  o f D e p r e s s i o n on A u t o m a t i c  Tasks l i n e of r e s e a r c h has found that depressed s u b j e c t s  perform more p o o r l y than normals on automatic t a s k s .  on effort-demanding but not  Cohen, Welngartner,  and Murphy (1982) were among the f i r s t examine d e p r e s s i v e s ' d i f f e r e n t i a l and more e f f o r t f u l t a s k s , normal  and  Smallberg, P l c k a r ,  i n v e s t i g a t o r s to  performance  on automatic  c o m p a r i n g depressed p a t i e n t s with  c o n t r o l s , they found that depressed p a t i e n t s were  more Impaired on tasks r e q u i r i n g s u s t a i n e d e f f o r t a list  (recalling  on nonsense s y l l a b l e s , m a i n t a i n i n g t h e i r g r i p on a  dynamometer) than on tasks r e q u i r i n g r e l a t i v e l y l e s s  effort  ( e x e r t i n g force on the dynamometer). S i m i l a r l y , Roy-Bryne, Weingarter, B l e r e r , Thompson, and Post  (1986) gave both e f f o r t f u l and automatic t a s k s to  depressed p a t i e n t s and normal a list  controls.  Subjects were given  of word p a i r s and they were asked to make one of four  p o s s i b l e judgments.  They were then asked to r e c a l l the  list  ( e f f o r t f u l task) or, when presented with the word-pair, were asked to i n d i c a t e which of the four judgments they had made on the word p a i r s  (presumably an automatic  task).  A d d i t i o n a l l y , s u b j e c t s were a g a i n presented with the word list new  (so now list.  t h i s word l i s t  They were then asked t o r e c a l l the t w i c e -  presented l i s t list  i s presented twice) along with a  ( e f f o r t f u l t a s k ) and, when presented with the  of word-pairs, to I n d i c a t e which of the word l i s t s  were  48 presented  twice.  Depressed p a t i e n t s performed worse than  the nondepressed s u b j e c t s only on the e f f o r t f u l Two  a d d i t i o n a l s t u d i e s , s i m i l a r l y , showed t h a t  depression  d i s r u p t s e f f o r t f u l but not automatic  G o l i n k o f f and occurrence recall  tasks.  Sweeney (1989) administered  t e s t s (automatic  i n p a t i e n t s and  controls.  There was  Cooper  Imageabillty  age-  and  IQ-matched normal  no d i f f e r e n c e i n frequency recognized  judgments, fewer words.  (1989) found that the e f f e c t s of  (automatic  process)  of s t o r y u n i t s were  comparable i n both depressed and  normal s u b j e c t s .  depressed s u b j e c t s showed poorer  recall  the s t r u c t u r e . o f the s t o r y ( e f f o r t f u l  process). ameliorate  a l s o f a c i l i t a t e performance on e f f o r t f u l but  on automatic t a s k s . administered s e l e c t i v e and  a f a c i l i t a t i o n that i s  r e s t r i c t e d to tasks r e q u i r i n g e f f o r t .  (Reus, Silberman,  not  When depressed p a t i e n t s were  amphetamine, there was  t h i s f a c i l i t a t i o n was  not seen f o r the automatic  But  tasks  Post, & Weingarter, 1979).  Automatic P r o c e s s i n g s t u d i e s In  Depression  i n t h i s s e c t i o n , I show t h a t depresslves process  However,  f o r u n i t s c e n t r a l to  From a d i f f e r e n t p e r s p e c t i v e , drugs that depression  of  r e c o g n i t i o n memory t e s t s to  but depressed s u b j e c t s r e c a l l e d and Watts and  frequency  task), verbal paired associate  ( e f f o r t f u l t a s k ) , and  depressed  processes.  depression-related s t i m u l i .  automatically  These s t u d i e s examined  automatic p r o c e s s i n g v i a the s e l f - r e f e r e n t encoding task, and  v i a p e r c e p t u a l and a t t e n t i v e b i a s e s .  49 S e l f - r e f e r e n t encoding task 3 t u d l e s .  Since much of the  c o g n i t i v e v u l n e r a b i l i t y r e s e a r c h has focused p r o c e s s i n g of s e l f - r e f e r e n t  information,  on the  i t i s appropriate  to examine some recent developments i n t h i s area. (1982) proposed t h a t s e l f - r e f e r e n t  Information  invoking automatic a t t e n t i o n a l responses.  event  ( c f . Logan, 1979;  S c h i f f r i n & Schneider,  i s capable of  He f i r s t  out t h a t automatic p r o c e s s i n g develops with r e l a t i v e l y c o n s i s t e n t experience  Bargh  pointed  frequent and  with the environmental  S c h l f f r l n & Dumais, 1981;  1977).  as the o r g a n i z i n g force behind  Since the s e l f social  i s implicated  Information  processing  ( c f . Markus, 1977), i t f o l l o w s t h a t people develop automatic a t t e n t i o n a l responses to s e l f - r e f e r e n t  information.  example, one's own name i s one of the r a r e s t i m u l i of breaking  capable  through the a t t e n t i o n a l b a r r i e r and be  c o n s c i o u s l y n o t i c e d i n the d i c h o t l c l i s t e n i n g task 1959).  For  (Moray,  On a d i c h o t l c l i s t e n i n g t a s k , Bargh (1982) found  that s e l f - r e f e r e n t  i n f o r m a t i o n r e q u i r e d fewer a t t e n t i o n a l  resources  when presented  t o the attended  resources  when presented  t o the unattended channel,  to n e u t r a l words.  channel,  but more relative  Furthermore, t h i s d i f f e r e n t i a l c a p a c i t y  a l l o c a t i o n occurred d e s p i t e s u b j e c t s ' lack of awareness of the r e j e c t e d channel,  as i n d i c a t e d by t h e i r  i n a b i l i t y to  s e l e c t the r e l e v a n t words l n a subsequent r e c o g n i t i o n t a s k . MacDonald and Kuiper  (1985) attempted to study the  issue of a u t o m a t i c i t y i n d e p r e s s i o n .  They asked  clinically  depressed and normal s u b j e c t s t o perform a memory load task  50 - to hold d i g i t s  i n memory - c o n c u r r e n t l y  r e f e r e n t encoding task.  with the s e l f -  I f s e l f - r e f e r e n t judgments are  r e l a t i v e l y automatic, then (a) the a d d i t i o n of the memory load task would lead to minimal d i s r u p t i o n In the performance of the s e l f - r e f e r e n t encoding task, and (b) Increasing  the number of d i g i t s on the memory load  task,  furthermore, would not a f f e c t s e l f - r e f e r e n t encoding performance.  task  MacDonald and Kuiper found no d i f f e r e n c e s In  the s i z e of the load e f f e c t as a f u n c t i o n of group membership (depressed, nondepressed) and a d j e c t i v e content (positive, depression-content).  These I n v e s t i g a t o r s  argued  that these f i n d i n g s support t h e i r hypothesis that the s e l f schema operates  automatically.  As Bargh and Tota (1988) pointed Kuiper*s c o n c l u s i o n  i s problematic.  to be c o n t e n t - s p e c i f i c .  out, MacDonald and The schema i s t h e o r i z e d  Thus, the p r e d i c t i o n c o n s i s t e n t  with the hypothesis i s the demonstration of a u t o m a t i c i t y only i n the p r o c e s s i n g depression-content  of schema-congruent s t i m u l i , that i s ,  a d j e c t i v e s f o r depressed s u b j e c t s and  p o s i t i v e a d j e c t i v e s f o r nondepressed s u b j e c t s . i n t e r a c t i o n i s not supportive  The lack of  of t h i s p r e d i c t i o n .  However,  t h i s f i n d i n g cannot be taken as lack of evidence f o r automaticity  of the self-schema, f o r there were d i f f i c u l t i e s  in i n t e r p r e t i n g the r e s u l t s .  These I n v e s t i g a t o r s measured  response l a t e n c i e s to the nearest  second.  D i f f e r e n c e s of as  l i t t l e as 20 msecs may be r e l i a b l e  i n d i c a t o r s of processing  differences  Thus, t h e i r apparent lack  (e.g., Posner, 1978).  51 of support may be due to the lack of p r e c i s i o n of t h e i r measures. S i m i l a r l y , Bargh and Tota  (1988) attempted to  demonstrate a u t o m a t i c i t y i n s e l f - r e f e r e n t i a l  judgments.  Using a c u t o f f c r i t e r i o n score of 10 on the Beck  Depression  Inventory  (Beck e t a l . , 1961) these  investigators  depressed  and nondepressed c o l l e g e students t o judge a  s e r i e s of depressed- and nondepressed-content  asked  a d j e c t i v e s as  to t h e i r d e s c r i p t I v e n e s s to the s e l f or to the average person.  Some s u b j e c t s held s i x d i g i t s  i n memory concurrent  with the judgment t a s k s , while the remaining s u b j e c t s had no concurrent memory load while making t h e i r  judgments.  The  r e s u l t s showed t h a t the memory load manipulation produced l n a s m a l l e r Increase  l n depressed  subjects' decision  latencies  for the d e p r e s s i o n - c o n t e n t a d j e c t i v e s than f o r the nondepressed-content found  adjectives.  The reverse p a t t e r n was  f o r the nondepressed s u b j e c t s ' judgments.  Thus, the  r e s u l t s are s u p p o r t i v e of the idea that a r e l a t i v e l y automatic  process  judgments.  i s used to make s e l f - r e f e r e n t i a l  Since the i n v e s t i g a t o r s used c o l l e g e students,  however, i t i s u n c e r t a i n whether the f i n d i n g would extend to clinical  depression.  Studies examining r e l a t i v e l y automatic  perceptual biases.  Another  process i n v o l v e s p e r c e p t i o n .  and Hemsley (1984) s e t out to determine  Powell  depressives'  r e c o g n i t i o n t h r e s h o l d s f o r unpleasant and n e u t r a l words. Using samples of depressed  I n p a t i e n t s and normal c o n t r o l s ,  52 they e s t a b l i s h e d a 50% r e c o g n i t i o n t h r e s h o l d for t a c h i s t o s c o p i c a l l y presented  words f o r each s u b j e c t .  then compared the r a t i o of unpleasant c o r r e c t l y recognized.  They  t o n e u t r a l words  Depressed s u b j e c t s showed a tendency  (p_ < .08) toward a higher r e c o g n i t i o n r a t i o of unpleasant t o n e u t r a l words.  The i n v e s t i g a t o r s argued that t h e i r  were supportive  of a p e r c e p t u a l bias i n c l i n i c a l  A r e l a t e d study by MacLeod, Tata, and was  results  depression.  Mathews (1987)  u n s u c c e s s f u l , however, i n documenting p e r c e p t u a l b i a s i n  c l i n i c a l depresslves. Powell  and  Using  the same stimulus  Hemsley (1984), these  words as  i n v e s t i g a t o r s employed a  l e x i c a l d e c i s i o n paradigm with samples of depressed p a t i e n t s and  normal c o n t r o l s ,  on a computer screen, a row of  a s t e r i s k s was d i s p l a y e d .  A f t e r one  replaced by a l e t t e r s t r i n g . by p r e s s i n g a key, a word.  second, t h i s was  Subjects were asked to respond  i n d i c a t i n g whether the l e t t e r s t r i n g was  In c o n t r a s t to Powell  and  Hemsley,  these  i n v e s t i g a t o r s found no i n t e r a c t i o n between s u b j e c t groups and  valence  hypothesis  of s t i m u l i .  The  r e s u l t s are c o n t r a r y to the  t h a t p e r c e p t i o n of mood-congruent  would be f a c i l i t a t e d  in depression.  Studies examining a t t e n t i v e b i a s e s . and  G o t l i b , McLachlan,  Katz (1988) attempted to document v i s u a l a t t e n t i o n a l  b i a s e s In d y s p h o r i c  c o l l e g e students.  Three types  p a i r s were t a c h i s t o s c o p i c a l l y presented: depressed-neutral, one  information  and  positive-depressed.  word was p r i n t e d above the other.  of word  positive-neutral, For each  trial,  A f t e r a 730 msec  53 p r e s e n t a t i o n of the word p a i r , two d i f f e r e n t c o l o u r r e p l a c e d the words.  Subjects  bars  were asked to r e p o r t which of  the two c o l o u r bars they perceived as appearing  first.  If  s u b j e c t s were a t t e n d i n g t o the depressed-content word when the colour bars appeared, the bar that masked t h a t word would be p e r c e i v e d as o c c u r r i n g e a r l i e r , because the p e r c e p t i o n of the other bar would require a s h i f t In a t t e n t i o n , g i v i n g r i s e t o the perception that the c o l o u r bar appeared The  later. r e s u l t s showed t h a t nondepressed s u b j e c t s showed a  greater a t t e n t i v e n e s s t o p o s i t i v e words, as e v i d e n t by a g r e a t e r percentage of judgments f o r bars appearing l o c a t i o n of the p o s i t i v e words.  Dysphoric  i n the  s u b j e c t s showed  an even-handedness i n t h e i r processing of the d i f f e r e n t word types;  they showed roughly equal rates of judgments f o r  both p o s i t i v e and depression-content i n v e s t i g a t o r s concluded  that t h i s  stimuli.  The  even-handedness p a t t e r n  f a i l e f l t-0 support- t h e i r hypothesis  of a t t e n t i o n a l b i a s i n  depression. Conclusions  about b i a s e s  draw from t h i s study,  i n depression  are d i f f i c u l t t o  however, because i t used m i l d l y  depressed c o l l e g e s t u d e n t s .  Other s t u d i e s using  different  i n f o r m a t i o n p r o c e s s i n g paradigms have produced t h i s evenhandedness e f f e c t f o r d e p r e s s i o n Davis,  and p o s i t i v e s t i m u l i  1979a), but when t h a t paradigm was a p p l i e d t o  c l i n i c a l l y depressed p a t i e n t s , there was a d e p r e s s i v e for  (e.g.,  the d e p r e s s i o n - r e l a t e d s t i m u l i  (e.g.,  Davis,  bias  1979b;  54  Davis  & unruh, 1981).  i t would be of t h e o r e t i c a l  interest-  to determine whether the paradigm from the G o t l i b e t a l . (1988) study  i s capable  of r e v e a l i n g a d e p r e s s i v e  a t t e n t i o n a l bias i n a sample of c l i n i c a l l y  depressed  patients. Other researchers have i n v e s t i g a t e d d e p r e s s i v e s ' a t t e n t i o n a l bias using a v e r s i o n of the Stroop task. stroop task  The  (stroop, 19 35) has f r e q u e n t l y been used by  c o g n i t i v e p s y c h o l o g i s t s t o study a t t e n t i o n a l processes. the s t r o o p task, the s u b j e c t ' s task the  In  i s t o name the c o l o u r of  ink i n which a word i s p r i n t e d .  In Stroop's  (1935)  study, s u b j e c t s took longer t o name the colour of the ink when.the base item was an incongruent printed  colour name (e.g 'red'  i n green) than when they were rows of x's.  Subsequent research  (e.g., K l e i n , 1964) has found  that any  word causes some i n t e r f e r e n c e , e s p e c i a l l y i f the word i s a s s o c i a t e d with an incongruent  c o l o r (e.g., sky, grass)  (Scheibe, Shaver, & C a r r i e r , 1967).  This d i s r u p t i o n of the  colour-naming performance i s thought to be due t o a l l o c a t i o n of a t t e n t i o n to more s a l i e n t aspects the stimulus words).  of the stimulus  The e f f e c t occurs without  (i.e.,  any apparent  I n t e n t i o n by the s u b j e c t s , so In t h i s respect the Stroop task taps  Into r e l a t i v e l y automatic  processing.  More r e c e n t l y , r e s e a r c h e r s have modified the Stroop task to examine c o g n i t i v e p r o c e s s i n g i n a f f e c t i v e d i s o r d e r s . Common t o these s t u d i e s i s the b a s i c task of c o l o u r naming of words t h a t are a f f e c t i v e  i n content.  55 G o t l i b and McCann (1984) were among the f i r s t  to a p p l y  the m o d i f i e d v e r s i o n of the Stroop task to the area of depression.  They asked m i l d l y depressed and  nondepressed  c o l l e g e students to name the c o l o u r s of depressed-, n e u t r a l - , and p o s i t i v e - c o n t e n t words as q u i c k l y as p o s s i b l e . The r e s u l t s were s u p p o r t i v e of a d e p r e s s i v e a t t e n t i v e  bias;  depressed s u b j e c t s showed longer response l a t e n c i e s to the depressed-content words than to e i t h e r the n e u t r a l - or the p o s i t i v e - c o n t e n t words, whereas the nondepressed s u b j e c t s d i d not show d i f f e r e n t i a l response l a t e n c i e s to the three types of words.  This e f f e c t has been r e p l i c a t e d  of c l i n i c a l l y depressed i n p a t i e n t s  i n a sample  ( G o t l i b & Cane, 1987).  In an i n t e r e s t i n g a p p l i c a t i o n of the Stroop task, Marks, W i l l i a m s , and Broadbent  (1986) demonstrated  that  p a t i e n t s a u t o m a t i c a l l y process s t i m u l i r e l a t e d to t h e i r psychopathology.  They s t u d i e d the Stroop performance  sample of p a t i e n t s who drug overdose.  had r e c e n t l y attempted  suicide  of a by  They found a g r e a t e r d i s r u p t i o n i n naming  words t h a t were more s p e c i f i c a l l y r e l a t e d to t h e i r psychopathology  (e.g., overdose, drug) than i n more g e n e r a l  negative emotional words (e.g., immature, h e l p l e s s ) . Furthermore, the extent of t h i s d i s r u p t i o n was  correlated  with l e v e l s of c u r r e n t depressed mood, r a t h e r than c u r r e n t anxiety.  56 Vulnerability  s t u d i e s Examining  Automatic  Processes  A review of s t u d i e s a d d r e s s i n g d e p r e s s i v e automatic p r o c e s s i n g as v u l n e r a b i l i t y f a c t o r s shows that t h i s i s a r e l a t i v e l y unexplored a r e a .  Two s t u d i e s are r e l e v a n t here.  W i l l i a m s and N u l t y (1986) asked whether emotional stroop d i s r u p t i o n r e f l e c t s c u r r e n t mood l e v e l or a more permanent trait  mood l e v e l .  They t e s t e d c o l l e g e students with the  Beck Depression i n v e n t o r y (Beck e t a l . , 1961) on two o c c a s i o n s , 1 year a p a r t .  The s u b j e c t s were given a Stroop  task u s i n g emotional words. interest:  s t a b l e depressed  Three groups  of s u b j e c t s are of  (those who were depressed a t  both t e s t i n g s e s s i o n s ) , s t a b l e nondepressed nondepressed  a t both s e s s i o n s ) , and unstable depressed  (those who t e s t e d depressed a t the f i r s t nondepressed  (those who were  a t the second s e s s i o n ) .  s e s s i o n , but t e s t e d  As expected, the  g r e a t e s t d i s r u p t i o n was found f o r the s t a b l e depressed s u b j e c t s , while the s m a l l e s t d i s r u p t i o n was observed f o r the s t a b l e nondepressed.  For the unstable depressed group, the  extent of the d i s r u p t i o n i n c o l o u r naming was p r e d i c t a b l e on the b a s i s of t h e i r lower  I n i t i a l mood l e v e l , r a t h e r than t h e i r  l e v e l a t time of t e s t i n g .  Again, a caveat i s extended  i n t h i s study's a p p l i c a b i l i t y t o c l i n i c a l i t employed  depression since  college students.  Using a c l i n i c a l  sample, G o t l l b and Cane (1987)  also  examined whether d e p r e s s i v e v i s u a l a t t e n t i o n a l bias i s a s t a b l e aspect of c o g n i t i v e p r o c e s s i n g i n depressed individuals.  Depresssed  p s y c h i a t r i c p a t i e n t s and  57 nondepressed c o n t r o l s were administered the Stroop task twice.  i n the f i r s t a d m i n i s t r a t i o n , the h o s p i t a l i z e d  depressed  p a t i e n t s took longer t o name the c o l o u r s of the  depressed-content  than f o r the nondepressed-content  whereas the response not d i f f e r  l a t e n c i e s of nondepressed s u b j e c t s d i d  f o r the three types of words.  Thus, the  d e p r e s s i v e a t t e n t i o n a l b i a s e f f e c t was r e p l i c a t e d . second  words,  The  a d m i n i s t r a t i o n was obtained upon symptomatic recovery  of the depressed  patients.  At t h a t s e s s i o n , the recovered  d e p r e s s i v e s ' performance resembled controls,  that of the nondepressed  i n d i c a t i n g that the d e p r e s s i v e a t t e n t i v e bias had  s h i f t e d with the a l l e v i a t i o n of depressed  mood.  I t appears,  u s i n g t h i s task, that a t t e n t i o n a l b i a s i s not a s t a b l e aspect of depressed  individuals.  Summarizing, depression appears  to a f f e c t automatic and  e f f o r t f u l c o g n i t i v e processes d i f f e r e n t i a l l y . evidence related  that d e p r e s s i v e s a u t o m a t i c a l l y process d e p r e s s i o n stimuli.  automatic this  There i s  A review of the l i t e r a t u r e  examining  processes as v u l n e r a b i l i t y markers suggests t h a t  Is a r e l a t i v e l y unexplored  area.  Out of the two  s t u d i e s , one showed negative r e s u l t s .  However, l n a  r e l a t i v e l y unexplored  area, one negative f i n d i n g should not  mean sudden death to that area. t u r n t o e x p l o r i n g automatic vulnerability  factors.  With t h i s  i n mind, I now  processes as candidates f o r  58 Chapter 5:  Statement of Research Problem and  General Method  I propose t h a t automatic related stimuli  i s a s e n s i t i v e measure of v u l n e r a b i l i t y  markers i n d e p r e s s i o n . f o l l o w i n g manner.  This idea was examined i n the  Three groups of s u b j e c t s were used:  c u r r e n t l y depressed, subjects.  p r o c e s s i n g of d e p r e s s i o n -  remitted depressed,  and nondepressed  These s u b j e c t s were given tasks which involve  p r o c e s s i n g t h a t i s e i t h e r e f f o r t f u l or automatic. months a f t e r t h i s experimental fill  Three  s e s s i o n , they were asked to  out a q u e s t i o n n a i r e which assessed  depressive  Four main hypotheses were examined: (a)  symptoms.  depressed  i n d i v i d u a l s would show depressive biases In the automatic tasks;  (b) r e m i t t e d depressed  performance on the automatic the c u r r e n t l y depressed  i n d i v i d u a l s ' p a t t e r n of tasks would resemble that of  individuals;  (c)  remitted  depressed  i n d i v i d u a l s ' p a t t e r n of performance on the e f f o r t f u l  tasks  would resemble t h a t of the nondepressed i n d i v i d u a l s ; and (d) measures of d e p r e s s i v e automatic p r e d i c t i v e of f u t u r e d e p r e s s i v e The  processes symptoms.  remainder of t h i s chapter  background f o r the tasks used.  would be  provides the conceptual  The i n t e n t of t h i s i s to  demonstrate the r e l a t i v e l y automatic  and e f f o r t f u l  of the t a s k s , u s i n g the assumption that automatic e f f o r t f u l processes  fall  the tasks are provided  on a continuum.  i n the subsequent  natures versus  More d e t a i l s of chapters.  59  Conceptual D e s c r i p t i o n of Tasks Used Three r e l a t i v e l y automatic tasks were used.  These  were: d i c h o t l c l i s t e n i n g , probe d e t e c t i o n , and I m p l i c i t memory t a s k s .  In a d d i t i o n t o the three automatic tasks,  s e l f - r e p o r t q u e s t i o n n a i r e s were a d m i n i s t e r e d . Automatic Thoughts Questionnaire,  These were:  Hopelessness Scale, and  the D y s f u n c t i o n a l A t t i t u d e Scale.  These were chosen as they  were developed under Beck and h i s c o l l e a g u e s ' c o g n i t i v e framework, and these measures have t r a d i t i o n a l l y been used l n the c o g n i t i v e v u l n e r a b i l i t y  literature.  In the d i c h o t l c l i s t e n i n g task are asked to repeat while  Despite  taking place. ear  to one ear,  messages to the  the I n s t r u c t i o n s to ignore the  unattended message, there considerable  presented  subjects  1973),  or shadow messages played  i g n o r i n g simultaneously  other ear.  (Cherry,  i s strong evidence  that  p r o c e s s i n g of the unattended information i s For example, when a word i n the unattended  i s a synonym of a simultaneously  presented  shadowed ear, shadowing slows down (Lewis, Squire, & Green, 1 9 7 4 ) .  In a study  word In the  1 9 7 0 ; Trelsman,  by McKay  (1973),  s u b j e c t s were l i k e l y to i n t e r p r e t the sentence 'she s a t by the bank' i n q u i t e d i f f e r e n t ways when the words ' r i v e r ' or 'money' occurred good evidence  i n the unattended channel.  t h a t the processing of the unattended message  can proceed unconsciously. (1982)  There i s a l s o  For example, s u b j e c t s i n Bargh's  study appeared t o be unaware of the content  unattended channel,  of the  l n t h a t they were unable to recognize  60 the r e l e v a n t words when shown to them l a t e r , processing subjects'  since  of the unattended message proceeds without i n t e n t i o n and  i s considered  awareness, t h i s type of  processing  to be r e l a t i v e l y automatic.  Another seemingly automatic process i s the  involuntary  a l l o c a t i o n of a t t e n t i o n to s a l i e n t aspects of  the  environment.  on  conversation  For example, one  may  at a p a r t y only to be  one's name spoken i n the context T h i s i s an Williams,  be  focused  Interrupted  of another  one  upon  hearing  conversation.  i l l u s t r a t i o n of the c o c k t a i l p a r t y phenomenon. Watts, MacLeod, and  Mathews (1988) provided  c l i n i c a l examples of the c o c k t a i l party phenomenon. had  a phobia of b i r d s .  with b i r d s , she  To avoid any  M.  M.  p o t e n t i a l encounters  developed extreme s e n s i t i v i t y to  bird-type  stimuli  i n her environment.  objects  s e v e r a l meters away, l e s t the object turn out to  a bird.  M.  frequently family.  M.  She  some  would avoid dark, f l a p p i n g  would n o t i c e l i v e and  dead b i r d s f a r more  i n her environment than would her  Williams  et a l . saw  friends  and  t h i s s e n s i t i v i t y to f e a r -  r e l a t e d s t i m u l i as an example of a t t e n t i o n bias s p e c i f i c t h i s p a r t i c u l a r psychopathology.  The  s t r i k i n g feature  t h i s a t t e n t i o n a l b i a s i s i t s seemingly i n v o l u n t a r y It i s very  l i k e l y that M. M. cannot ignore  aspects of her environment, even i f she  al.  We  to  of  nature.  bird-like  wanted t o .  i n v o l u n t a r y nature of a t t e n t i o n a l bias i s s t a t e d by et  be  This Williams  (iy88):  assume that a t t e n t i o n a l bias can be s a i d to have  61  occurred when there i s a d i s c r e t e change i n the direction  i n which a person's  a t t e n t i o n i s focused so  that he/she becomes aware of a part or aspect of h i s / her environment.  We a l s o assume t h a t such a change  (a) may take place i n any sense modality;  (b)  is  perceived as being passive or I n v o l u n t a r y but can operate v o l u n t a r i l y and (c) i s normally p e r c e i v e d to be contingent upon a d i s c r e t e change (onset or o f f s e t ) i n the  ' i n t e r n a l ' or 'external* environment of the person,  (p. 54, emphasis mine). A t t e n t i o n a l b i a s e s , then, appear t o be the r e s u l t of r e l a t i v e l y automatic  processes.  This i n v o l u n t a r y c a p t u r i n g  of a t t e n t i o n by s a l i e n t aspects of the environment has a l s o been e x p e r i m e n t a l l y i n v e s t i g a t e d by the v i s u a l  probe  d e t e c t i o n paradigm (MacLeod, Mathews, & Tata, 1986). t h i s paradigm, p a i r s of words are b r i e f l y presented and  bottom p a r t s of a computer screen.  to read the top word aloud. small dot) i s presented  In on top  S u b j e c t s are asked  On some t r i a l s , a probe (a  i n e i t h e r of the l o c a t i o n s i n which  the words appeared, and when t h i s occurs, s u b j e c t s are to press a button as q u i c k l y as p o s s i b l e .  C o n s i d e r the c a s e  where one of the two words presented contained information.  self-relevant  Subjects* a t t e n t i o n would be drawn to the area  where that word appeared.  I f s u b j e c t s ' a t t e n t i o n were drawn  to an area where a probe p r e s e n t a t i o n f o l l o w e d , they would be quicker to d e t e c t the probe.  On the other hand, i f  subjects'  attention  probe appeared, Yet the  t h e y would  another  Implicit  were drawn e l s e w h e r e  task  that  memory t a s k .  be  slower  subjects' event  Implicit  on a s u b s e q u e n t  illustrated (as  memory I s s a i d  task,  attempt  Claparede,  amnesic p a t i e n t  had  recollection  w i t h him.  In a s i m i l a r  b e i n g asked  an  inexplicable  were more l i k e l y  information  1982).  memory, w h i c h  in a deliberate component  Mandler  of the  the a c t i v a t i o n  that  s t r e n g t h e n s the  that  in  one  employs a  to r e c a l l  with  or  ones p r e s e n t e d p r e v i o u s l y  Implicit  or  hands  after  homophones  memory i s c o n t r a s t e d  i s the a b i l i t y to intentional  recall  manner  (e.g.,  SRET).  (1980) p r o p o s e d  from  Dr.  homophones c o n s i s t e n t  t h e y were u n a b l e as  the  r e l u c t a n c e t o shake  instrument  to s p e l l  t h e words t h e y used  with e x p l i c i t  recall  of h a v i n g met  f a s h i o n , amnesic p a t i e n t s ,  ( e . g . , "Name a m u s i c a l  & Witherspoon,  of h i s  L a t e r t h a t day,  questions that disambiguated  meaning, a l t h o u g h  (Jacoby  the  had  no  but  recognize  strikingly  w h i l e h o l d i n g a p i n In h i s hand,  Claparede,  that  that  In t h e c o u r s e  shook hands w i t h an a m n e s i c p a t i e n t .  reed"),  of  to r e c a l l  T h i s phenomenon was  occur  by t h e n i n e t e e n t h c e n t u r y n e u r o l o g i s t C l a p a r e d e  Dr.  direction  to  affects  i n the absence  r e p o r t e d l n E l l e n b e r g e r , 1970).  rounds,  the  to d e t e c t i t .  or e x p e r i e n c e  c o n s c i o u s or d e l i b e r a t e  or e x p e r i e n c e .  where  does not depend on a w a r e n e s s i s  when memory f o r a r e c e n t e v e n t performance  from  that  implicit  memory  of a mental  r e p r e s e n t a t i o n , or  Internal  of  structure  that  results schema,  63  representation but  not  ( i n t e g r a t i o n ) , thus making i t more a c c e s s i b l e  n e c e s s a r i l y more r e t r i e v a b l e .  depends on the  extent to which the a c t i v a t e d  r e l a t e d to other information  at the  Mandler and  can  be a c t i v a t e d  h i s colleagues  Graf, & K r a f t , 1986)  (Graf  associated  to serve as r e t r i e v a l & Mandler, 1984;  f u r t h e r proposed  subject  c o n t r o l l e d , and  processing  conscious.  cues.  Mandler,  that  a c t i v a t i o n / i n t e g r a t i o n i s regarded as being automatic, whereas e l a b o r a t i v e  schema i s  time of encoding  ( e l a b o r a t i o n ) , thereby ensuring that representations  E x p l i c i t memory  relatively  is strategic,  64 Chapter 6: The manner.  Method  r e s t o£ the t h e s i s i s organized  i n the f o l l o w i n g  The s u b j e c t s s e c t i o n i s presented  first.  It  c o n s i s t s of a d e s c r i p t i o n of the measures used i n s u b j e c t c l a s s i f i c a t i o n , a d i s c u s s i o n of the s u b j e c t s e l e c t i o n criteria,  and a d e s c r i p t i o n of the s u b j e c t  characteristics.  Next, the o v e r a l l procedure s e c t i o n provides an overview of how the study was conducted.  The present  followed  on the d i c h o t l c l i s t e n i n g ,  by separate  chapters  chapter i s  probe d e t e c t i o n , and i m p l i c i t memory t a s k s , and on the s e l f report questionnaires.  Each of these  chapters  contains a  d e s c r i p t i o n o f the task and the main dependent measures, the g e n e r a l procedure, a l i s t  of hypotheses that were examined,  the r e s u l t s , and a b r i e f summary. between-groups comparisons. described.  The r e s u l t s focus on the  Next, the follow-up data are  F i n a l l y , the r e s u l t s of a l l the tasks are  compared and d i s c u s s e d . Subjects Measures D S M - I I I - R diagnoses.  The D i a g n o s t i c and S t a t i s t i c a l  Manual f o r Mental Disorders  (3rd ed. - Revised)  (DSM-III-R;  American P s y c h i a t r i c A s s o c i a t i o n , 1987) was used f o r d i a g n o s i s of Major Depressive  Episode  D S M was chosen s i n c e i t represents  and Dysthymia.  The  the most prevalent  d i a g n o s t i c system i n Canada (Junek, 1983).  The D S M has a l s o  a d d i t i o n a l merits.  I t Is intended  t o be an a t h e o r e t i c a l  d i a g n o s t i c system.  Furthermore, D S M diagnoses r e f l e c t  65  clinical  c o n s e n s u s on what symptoms c o n s t i t u t e t h e v a r i o u s  disorders. To date, l i t t l e  published  research  r e v i s e d v e r s i o n of the DSM-III.  However,  s t u d i e s are a v a i l a b l e f o r DSM-III. reliability  statistics  i s a v a i l a b l e f o r the reliability  In two f i e l d  trials,  f o r Major Depressive D i s o r d e r s  were  kappas of .68 and .80 (American P s y c h i a t r i c A s s o c i a t i o n , 1980),  suggesting  adequate agreement among r a t e r s .  Schedule f o r A f f e c t i v e D i s o r d e r s The  Schedule f o r A f f e c t i v e D i s o r d e r s  (SADS; E n d i c o t t  the  t o increase r e l i a b i l i t y of s u b j e c t s .  SADS was to provide  Diagnostic diagnoses.  Criteria,  Interview  I t was developed to provide  I n v e s t i g a t o r s with a standard  evaluations  Schizophrenia  d i a g n o s t i c d e c i s i o n s on a wide v a r i e t y  of p s y c h i a t r i c d i s o r d e r s .  order  and  Schizophrenia.  & S p i t z e r , 1978) Is a s t r u c t u r e d  designed t o provide  research  and  clinical  procedure i n  of d i a g n o s t i c and d e s c r i p t i v e  Although the o r i g i n a l diagnoses a c c o r d i n g  i n t e n t of  t o Research  i t can be adapted to provide  Three v e r s i o n s  DSM-III-R  of the SADS are a v a i l a b l e :  the  r e g u l a r v e r s i o n , the l i f e t i m e v e r s i o n , and the change version.  This t h e s i s used a modified  v e r s i o n of the  1ifetime-SADS - - the v e r s i o n t h a t was used i s based on o n l y those items t h a t p e r t a i n to the assessment of l i f e t i m e incidence  of depression,  thought d i s o r d e r , and mania (see  Appendix A ) . Psychometric p r o p e r t i e s of the SADS are considered t o be good.  In p a r t i c u l a r , the SADS has good  reliability.  66  Based on 150 reported more,  i n t e r v i e w s , E n d i c o t t and  inter-rater  of depression  .95 or diagnoses  SADS i n t e r v i e w s , S p i t z e r , E n d i c o t t , and  (1978) r e p o r t e d kappa c o e f f i c i e n t s of diagnoses  (1978)  r e l i a b i l i t y c o e f f i c i e n t s of  w i t h r e s p e c t to r e l i a b i l i t y  made through  Spitzer  .90 and  of major depressive d i s o r d e r and  disorder, respectively.  Robins  .81 f o r  minor d e p r e s s i v e  In terms of concurrent  validity,  the SADS c o r r e l a t e s moderately with other s c a l e s of depression.  I t c o r r e l a t e s .42 with the depression s c a l e of  the Katz Adjustment Scale  (Katz & L y e r l y , 1963), and  .68  with the d e p r e s s i o n s c a l e . o f the Symptom C h e c k l i s t ( D e r o g a t l s , Lipman, & Covi, 1973). Hamilton Rating Scale for Depression. R a t i n g Scale f o r Depression Appendix B)  (HRSD; Hamilton,  s e v e r i t y of d e p r e s s i o n I t Is not  The  c o n t a i n s 21 items, items  Intended  as a d i a g n o s t i c The  see  as  instrument.  o r i g i n a l version  17 of which are s c o r e d .  The  remaining  ( d i u r n a l v a r i a t i o n , d e p e r s o n a l i z a t i o n , paranoia, are not scored s i n c e they were  e i t h e r to be unrelated to the s e v e r i t y of depression  or appeared too i n f r e q u e n t l y .  The  24-ltem v e r s i o n i n c l u d e s  four c o g n i t i v e items, a s s e s s i n g hopelessness, and  1967;  for I n d i v i d u a l s a l r e a d y diagnosed  obsessive-compulsiveness) found  1960;  HRSD provides an index of  S e v e r a l v e r s i o n s are a v a i l a b l e .  four  Hamilton  i s h i s t o r i c a l l y the most commonly used i n t e r v i e w  measure of d e p r e s s i o n .  depressed.  The  worthlessnes3.  helplessness,  However, most r e s e a r c h e r s do not  score  67 t h e s e c o g n i t i v e items. of  This study used the 24-item v e r s i o n  the s c a l e , but r e l i e d on only the 17 s c o r a b l e  items.  For the 17 s c o r a b l e items, the t o t a l range of s c o r e s i s from 0 t o 5 2 , where higher scores are suggestive of g r e a t e r G u i d e l i n e s f o r I n t e r p r e t i n g HRSD  s e v e r i t y of d e p r e s s i o n . scores are provided  by Shaw, v a l l i s ,  and McCabe  HRSD s c o r e s of s i x or below are c o n s i d e r e d nondepressed  (1985).  to r e f l e c t  f u n c t i o n i n g , scores between 7 and 17 r e f l e c t  mild l e v e l s of d e p r e s s i o n , scores between 18 and 24 r e f l e c t moderate l e v e l s of depression, and scores greater than 25 r e f l e c t severe The  l e v e l s of d e p r e s s i o n .  HRSD i s t y p i c a l l y scored a f t e r a c l i n i c a l  Interview. interview  To increase r e l i a b i l i t y ,  a semi-structured  (see Appendix C) was used based on i n t e r v i e w  probes provided by Klerman, Weissman, R o u n s a v i l l e , and Chevron ( 1 9 8 4 ) and using the s c o r i n g g u i d e l i n e s provided by Beckham and Leber the HRSD are good.  (1985).  Inter-rater r e l i a b i l i t y  data on  In a survey of r e s e a r c h r e p o r t s oh the  HRSD from 1967 t o 1 9 7 9 , Hedlund and Vieweg (1979) c i t e d studies that reported of  .84 or above.  inter-rater r e l i a b i l i t y  Although  coefficients  Hamilton recommends that the HRSD  i s most e f f e c t i v e l y used by experienced  clinicians  1986),  the HRSD can be used by novice r a t e r s  minimal t r a i n i n g .  A f t e r 5 hours of t r a i n i n g , the three  (Hamilton,  undergraduates used l n t h i s study reached reliabilities  of . 7 6 .  nine  inter-rater  Furthermore, each of these  three  with  68  undergraduates'  mean r a t i n g s f o r four expert The  . 8 2 with the  r a t i n g s correlated at least judges.  HRSD has demonstrated moderate a s s o c i a t i o n s with  other measures of d e p r e s s i o n .  Based on a survey of a wide  v a r i e t y of s t u d i e s , Hedlund and Vieweg ( 1 9 7 9 )  reported  median c o r r e l a t i o n s between the HRSD and Beck  Depression  Inventory of . 5 8 , the Zung S e l f - R a t i n g Depression .45,  Scale of  and the Minnesota M u l t i p h a s i c P e r s o n a l i t y Inventory -  Depression  s c a l e of . 4 4 .  The HRSD i s s e n s i t i v e t o change i n  the s e v e r i t y of d e p r e s s i o n , as evidenced  by i t s frequent use  in drug outcome s t u d i e s . Beck Depression Inventory  Inventory.  The Beck  Depression  (BDI; Beck e t a l . , 1 9 6 1 ; see Appendix D) i s the  most f r e q u e n t l y used s e l f - r e p o r t s e v e r i t y of d e p r e s s i o n .  Inventory t o assess  The BDI provides a comprehensive  survey of d e p r e s s i o n symptomatology without p a r t i c u l a r theory of e t i o l o g y of d e p r e s s i o n . respondent depression.  I t asks the  t o d e s c r i b e h i s or her current l e v e l of The s c a l e contains 21 items where each item  c o n s i s t s of four s e l f - e v a l u a t i v e statements severity.  r e f l e c t i n g any  Each Item i s scored from 0 t o 3 ,  s c a l e score ranging from 0 to 6 3 .  of i n c r e a s i n g yielding a full  G e n e r a l l y recommended  g u i d e l i n e s f o r i n t e r p r e t i n g BDI scores are the f o l l o w i n g :  0  to 9 r e f l e c t nondepressed l e v e l s of f u n c t i o n i n g , 10 t o 15 r e f l e c t mild l e v e l s of d e p r e s s i o n , 16 t o 23 r e f l e c t moderate l e v e l s of d e p r e s s i o n , and 24 t o 63 r e f l e c t severe depression  (Shaw, V a l l i s ,  & Mccabe,  1985).  l e v e l s of  69 Much research & Garbin,  1988).  Is a v a i l a b l e on the BDI The  ( c f . Beck,  r e s u l t s suggest that the BDI  s a t i s f a c t o r y i n t e r n a l consistency.  Steer,  has  Based on s t u d i e s done  between 1961-1986, a meta-analysis of the BDI's i n t e r n a l consistency .86  estimates y i e l d e d a mean c o e f f i c i e n t alpha  for p s y c h i a t r i c p a t i e n t s and  patients  (Beck et a l . , 1988).  Burkhan (1979) reported c o e f f i c i e n t of The validity. .56  BDI  .78  .81  for  Furthermore, O l i v e r  over a period of three  Adjective Checklist  1967;  Williams,  In a d d i t i o n , the BDI  Burkhar, Gynther,  a l . , 1963;  Metcalfe  S a l k i n g , 1969).  c o r r e l a t e s .62  i n outcome s t u d i e s .  & Goldman, 1965;  F i n a l l y , the BDI  r e f l e c t i v e of symptom changes, as  1963;  Barlow, & Agras,  with c l i n i c i a n s ' g l o b a l r a t i n g s of d e p r e s s i o n  O l i v e r , & Mcclure, 1978;  use  the M u l t i p l e A f f e c t  Nussbaum, W i t t i g , Hanlon, & Kurland,  Zung, 1969).  from  P e r s o n a l i t y Inventory - Depression  (Bloom & Brady, 1968;  Schwab, Bialow, & Holzer,  et  concurrent  s c a l e f o r Depression,  Scale, the Zung S e l f - R a t i n g Scale, and  .77  weeks.  moderate to good c o r r e l a t i o n s ranging  the Minnesota M u l t i p h a s i c  & Fromuth, 1980;  and  a test-retest r e l i a b i l i t y  to .80 with the Hamilton Rating  1972;  nonpsychiatric  a l s o shows a reasonable degree of  I t has  of  i n d i c a t e d by  to  (Bumberry, Nussbaum  is i t s frequent  70  Subject  Classification  Criteria  This s e c t i o n d e s c r i b e s the c r i t e r i a selection.  used for s u b j e c t  Three groups of s u b j e c t s were used.  a c u r r e n t l y depressed group (CDG; depressed group (RDG;  n = 20), a r e m i t t e d  n = 20), and  community c o n t r o l s (NDG;  They were:  a group of nondepresssed  n = 20).  A l l s u b j e c t s had  to be  between the ages of 18 to 65, have a minimum of e i g h t h grade education  or possess s u f f i c i e n t reading a b i l i t y to complete  the s e l f - r e p o r t s c a l e s u n a s s i s t e d , and hearing  impairment.  they met  In a d d i t i o n , s u b j e c t s were excluded  the D i a g n o s t i c and  Disorders  ( 3 r d ed.  could not have a if  S t a t i s t i c a l Manual f o r Mental  - Revised) (DSM-III-R; American  P s y c h i a t r i c A s s o c i a t i o n , 1987)  diagnoses for b i p o l a r  I l l n e s s , substance use d i s o r d e r , organic b r a i n syndrome, mental r e t a r d a t i o n , or s c h i z o p h r e n i a  and  other  psychotic  disorders. Subjects the  were c l a s s i f i e d  following c r i t e r i a .  group met  i n t o the d i f f e r e n t groups by  Subjects  the DSM-III-R c r i t e r i a  Episode or Dysthymia. Appendix E.  i n the c u r r e n t l y depressed for Major  Depressive  These c r i t e r i a are reproduced i n  In a d d i t i o n , assurances were made t h a t  these  s u b j e c t s were i n a depressed s t a t e at the time of t e s t i n g , as  Indicated by Beck Depression  al.,  1961)  Rating 1986)  scores  of 15 or more and  Scale f o r Depression scores  Inventory  of 17 or more.  undergoing c o g n i t i v e therapy  (BDI;  24-item  Beck et  v e r s i o n Hamilton  (HRSD; Hamilton, 1960,  1967,  These s u b j e c t s could not since cognitive  therapy  be  71 e x p l i c i t l y attempts t o a l t e r al.,  1979).  the d e p r e s s i v e schema (Beck et-  Subjects undergoing  were a l s o excluded, been suggested  e l e c t r o c o n v u l s i v e therapy  because e l e c t r o c o n v u l s i v e therapy has  t o a l t e r c o g n i t i v e f u n c t i o n i n g , a t l e a s t on a  short term b a s i s (Squire, S l a t e r , & M i l l e r , Subjects i n the remitted depressed one  previous episode  of major d e p r e s s i o n  1981).  group had a t l e a s t (as assessed by  SADS - l i f e t i m e prevalence, see Appendix A), but were not a t the time  of t e s t i n g , undergoing  assessed  by BDI scores of 14 or l e s s and HRSD scores of 16  or l e s s .  As w e l l , any s u b j e c t s who had r e c e i v e d  e l e c t r o c o n v u l s i v e treatments past were The  a d e p r e s s i v e episode, as  or C o g n i t i v e Therapy l n the  excluded. two c l i n i c a l  samples were r e c r u i t e d  from the  i n p a t i e n t and o u t p a t i e n t wards of the U n i v e r s i t y H o s p i t a l U n i v e r s i t y of B r i t i s h Columbia s i t e .  The s u i t a b i l i t y of the  p a t i e n t samples were i n i t i a l l y screened  by c o n s u l t a t i o n with  the n u r s i n g s t a f f and the h o s p i t a l c h a r t s . Subjects i n the nondepressed group had no h i s t o r y of major d e p r e s s i o n and, a t the time of t e s t i n g , were not depressed  as d e f i n e d by BDI scores of 14 or l e s s and HRSD  scores of 16 or l e s s .  The community c o n t r o l sample was  a  r e c r u i t e d through  advertisements  placed on b u l l e t i n boards  at three community c e n t r e s , two a c q u a t i c c e n t r e s , a dance s c h o o l , and three community  libraries.  72 Subject C h a r a c t e r i s t i c s A total  o f 72 s u b j e c t s  were  Initially  recruited.  of  the nondepressed  community c o n t r o l s were e x c l u d e d ,  it  was f o u n d d u r i n g  the experimental  dlagnosable by  previous  episode  the SADS-Llfetlme  were e x c l u d e d  Inconsistent picture: hospital of  less  o f major d e p r e s s i o n ,  Interview.  when t h e i r  psychiatrist  15. not  three  subjects  s u c c e s s f u l l y complete  subjects  could  whereas one had a v i s i o n displayed The subjects consisted remitted  time  two task,  not read  60 i n d i v i d u a l s w i t h  The c u r r e n t l y d e p r e s s e d  depressed  group c o n s i s t e d  A l l subjects  words  20  group  a list  of t h e i r  of t e s t i n g ,  medications  undergoing  medications  o f t h e 20 r e m i t t e d  of 3 i n p a t i e n t s and 17  i n the c u r r e n t l y depressed  were, a t t h e t i m e o f t e s t i n g ,  Eight  tasks:  could  o f 13 I n p a t i e n t s and 7 o u t p a t i e n t s , w h i l e t h e  outpatients.  and  than  screen.  sample c o m p r i s e d  In e a c h g r o u p .  of l e s s  the d i c h o t i c l i s t e n i n g  score  depressive  because they  p r o b l e m and c o u l d  on t h e computer final  BDI s c o r e  were d r o p p e d  score  had a H a m i l t o n  the experimental  not perform  by t h e  produced a Hamilton  t h a n 17, I n d i c a t i n g t h e p r e s e n c e o f a  Another  subjects  measures gave an  individual  mood, b u t p r o d u c e d an I n c o n s i s t e n t  had a  as g i v e n  one I n d i v i d u a l who was r a t e d as d e p r e s s e d  when  they  Two o f t h e p a t i e n t  depression  t h a n 17; and a n o t h e r  of g r e a t e r  session that  Five  i n Appendix F.  s u b j e c t s were, a t t h e  on a n t i d e p r e s s a n t s ,  i s provided  pharmacotherapy,  Is p r o v i d e d  depressed  group  and a l i s t , o f t h e i r  i n A p p e n d i x F.  Nineteen subjects i n  73 the c u r r e n t l y d e p r e s s e d  g r o u p met DSM-III-R  c r i t e r i a for  Major Depressive Episode, whereas one met DSM-III-R c r i t e r i a for Dysthymia.  A l l s u b j e c t s i n the remitted depressed  group  has had a t l e a s t one p r e v i o u s episode that met DSM-III-R criteria  f o r Major Depressive  The  p a t i e n t s were asked  Episode. t o estimate the number of  previous episodes of d e p r e s s i o n . The c u r r e n t l y s u b j e c t s estimated an average of d e p r e s s i o n p r i o r They ranged  depressed  of 2 . 5 6 (SD = 2 . 7 9 ) episodes  t o t h e i r c u r r e n t d e p r e s s i v e episode.  from having no episodes of d e p r e s s i o n other than  t h e i r c u r r e n t d e p r e s s i v e episode, t o 12 episodes of d e p r e s s i o n p r i o r t o t h e i r c u r r e n t d e p r e s s i v e episode. estimated, at the time of t e s t i n g ,  t h e i r average  They  d u r a t i o n of  t h e i r present d e p r e s s i v e episode as 2 7 . 2 7 months (SD = with a range  38.97),  The  from one month t o 132 months.  remitted depressed  s u b j e c t s estimated t h e i r  average  number of previous episodes of d e p r e s s i o n as 3 . 0 6 (SD = 1.62)  with a range  episodes.  from one p r i o r  For t h i s group,  episode t o s i x p r i o r  the average  length of r e m i s s i o n  from the l a s t episode was estimated as 4 2 . 4 9 months (SD = 74.83)  with a range  from one month t o 216 months.  Demographic and s o c i a l f a c t o r s . characteristics  The demographic  of the s u b j e c t s a r e summarized  In Table 1 .  The CDG c o n s i s t e d of 13 women and 7 men, the RDG c o n s i s t e d of 16 women and 4 men, while the NDG c o n s i s t e d of 13 women and  7 men.  Their ages ranged  o v e r a l l average  of 3 9 . 9  from 23 t o 65 years with an  (SD = 1 1 . 2 8 )  years. i  74  "Table 1 Demographic c h a r a c t e r i s t i c s of Subject Groups  CDG Age  M SD  RDG  NDG  n  40.35 (8.63)  47 .65 (11.01)  31.70 (8.07)  <.001*  13/7  16/4  13/7  N.S.+  Marital status: Marrled/Separated, d i v o r c e d , or widowed/single  10/6/4  14/3/3  11/3/6  N.S.+  No. of c h i l d r e n M SD  1.30 ' (1.26)  1.65 (1.10)  .75 (1.10)  N.S. *  No. of years of M education SD  14.30 (3.13)  14.65 (3.56)  15.75 (1.71)  N.S.*  Sex r a t i o : (female/male)  Employment s t a t u s : employed/not employed due t o d i s a b i l i t y / umemployed 6/10/4 Socioeconomic s t a t u s M SD  141.25 (93.34)  11/2/7  18/1/1  162.14 (111.83)  190.82 (114.29)  <.05  +  N.S.*  Note. CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group. NDG = Nondepressed group. + Based on chi-square s t a t i s t i c . * Based on a n a l y s i s of v a r i a n c e . Socioeconomic s t a t u s estimates based on B l i s h e n & McRoberts (1975).  75 Chi square t e s t s and analyses  of v a r i a n c e were  conducted on the measures of s u b j e c t s c h a r a c t e r i s t i c s .  The  r e s u l t s show t h a t the three groups d i d not d i f f e r •significantly  i n p r o p o r t i o n of males and females  ( %i t2,N = 2  60) = 1.43, p_ > .05), m a r i t a l s t a t u s ( *f3~(6, N = 60) = 6.18, p_ > , 0 5 ) , number of c h i l d r e n  (F(2,57) = 3.07, p_ > . 0 5 ) ,  number of years of e d u c a t i o n  (F(2,57) = 1.35, p_ > .05), and  socioeconomic differ  s t a t u s (F(2,57) = .90, p_ > . 4 2 ) , but d i d  s i g n i f i c a n t l y with r e s p e c t to employment s t a t u s (^t " 2  (4,N = 60) = 22.10, p_ < .001). patients' status:  The l a t t e r  result  reflects  the u n e m p l o y a b i l i t y of the two p a t i e n t  groups i s due t o the d i s a b l i n g e f f e c t s of the d e p r e s s i o n . In a d d i t i o n , the three groups tended to d i f f e r in t h e i r  significantly  age (F(2,57) = 14.66, p_ < .001, MSe = 86.97),  with  Tukey comparisons I n d i c a t i n g t h a t s u b j e c t s i n the RDG are s i g n i f i c a n t l y o l d e r than groups (RDG v s . CDG:  the s u b j e c t s i n the other two  g ( 3 , 5 7 ) = 3.49, p. < .05; RDG vs. NDG:  q(3, 57) = 7,63, p_ < .01), and the s u b j e c t s i n the c u r r e n t l y depressed  group being s i g n i f i c a n t l y o l d e r than the s u b j e c t s  i n the nondepressed group, g(3,57)  = 4.14, p_ < .01. The  importance of t h i s age d i f f e r e n c e between groups w i l l be s p e c i f i c a l l y addressed  i n the r e s u l t s s e c t i o n .  76  Depression data.  The  BDI  and  the HRSD were used as  measures of s e v e r i t y of d e p r e s s i o n . in Table  The  data are summarized  2,  An one-way a n a l y s i s of variance  (F(2,57) = 96.44,  .001, MSe  = 48.11) conducted  confirmed  that the groups were d i s c r i m i n a b l e on the b a s i s of  their  scores.  BDI  Furthermore,  scores  Based on Tukey comparisons, the CDG  s i g n i f i c a n t l y higher BDI 16.12, p_ < .01)  across groups on the BDI  p_<  and  NDG  the RDG  scores than the RDG (g(3,57 ) = 18 . 64,  and  the NDG  d i f f e r e n t with r e s p e c t to t h e i r BDI  (g(3,57) =  p_ <  were not  had  .01).  significantly  scores  (g(3,57) =  2.52,  p_ > .05) . With r e s p e c t to the HRSD s c o r e s , i n i t i a l analyses were conducted Ten  to ensure  adequate r e l i a b i l i t y  of the 60 i n t e r v i e w s were taped and  by an experienced researcher.  Kent and  reliabilities analysis.  rated  p s y c h o l o g i s t and  F o s t e r (1970) suggest  ratings. Independently  depression that  be computed on the u n i t s used f o r  Thus, a Pearson-product  c o e f f i c i e n t was interviews.  clinical  of the  The  statistical  moment c o r r e l a t i o n  computed on the o v e r a l l r a t i n g s from obtained r of .99  10  (p_ < .001) shows a high  l e v e l of agreement among the r a t e r s . s y s t e m a t i c bias of one  the  To check f o r  r a t e r c o n s i s t e n t l y s c o r i n g higher  than the other r a t e r , Hartmann (1977) recommends computing a t - t e s t on the mean r a t i n g s for each observer. nonsignificant t-test  ( t ( 8 ) = .06, p_>  absence of t h i s type of b i a s .  A  .05) suggests  an  Table 2 Depression Measures a t Time of T e s t i n g  CDG  RDG  NDG  Measures BDI  M SD  30.80 (11.01)  5.80 (4.11)  1,90 (2.49)  HRSD  M SD  28.53 (5.83)  5.67 (5.09)  2.10 (2.17)  Note. CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group. NDG = Nondepressed group. BDI = Beck Depression Inventory. HRSD = Hamilton Rating Scale f o r D e p r e s s i o n .  78 Given s u f f i c i e n t  reliability  of the HRSD s c o r e s , a  between-groups a n a l y s i s of v a r i a n c e was then computed and was s i g n i f i c a n t ,  F ( 2 , 5 7 ) = 1 7 0 . 5 8 , p_ < . 0 0 0 1 , MSe = 2 2 . 4 2 .  Using Tukey comparisons, the CDG had s i g n i f i c a n t higher HRSD scores than both the RDG NDG  (g( 3, 57 ) = 2 1 . 4 2 ,  ( g ( 3 , 5 7 ) = 2 1 . 3 9 , p_ < .01) and the  p_ < . 0 1 ) . A d d i t i o n a l l y , the RDG d i d  not have s i g n i f i c a n t l y higher HRSD scores than the NDG  (g(3, 57) = 3 . 0 7 , p_ > .05) . In summary, the groups of s u b j e c t s had the expected p a t t e r n of d e p r e s s i o n s c o r e s .  The CDG c l e a r l y had higher  d e p r e s s i o n scores than the other two groups, whereas the RDG and NDG were roughly equated f o r d e p r e s s i o n s c o r e s . Overall The  study was conducted  was conducted Building.  i n two phases.  The f i r s t  phase  i n a l a b o r a t o r y l o c a t e d i n the Psychology  A l l s u b j e c t s were t e s t e d i n d i v i d u a l l y . A l l  s u b j e c t s gave informed  consent  Emotions" (see Appendix A). participate presented  Procedure  t o a study of "Thoughts and  Subjects were f i r s t  In the I m p l i c i t memory t a s k .  first  This task was  so t h a t the words from the subsequent tasks  would not serve as p o t e n t i a l primes. and v i s u a l probe tasks f o l l o w e d . these two tasks was determined participated  asked t o  The d i c h o t l c  listening  The order of a d m i n i s t e r i n g  randomly.  Subjects  then  l n an i n t e r v i e w (see Appendix H), which  i n v o l v e d the c o l l e c t i n g the f o l l o w i n g i n f o r m a t i o n : demographic i n f o r m a t i o n , h i s t o r y of thought mania, Hamilton  d i s o r d e r and  R a t i n g Scale s c o r e s , h i s t o r y of d e p r e s s i o n  79  (for  nondepressed community c o n t r o l s  only),  and  previous episodes of d e p r e s s i o n (for the two groups o n l y ) .  number  o£  depressed  F i n a l l y , s u b j e c t s were asked to complete  the  Beck Depression Inventory, the D y s f u n c t i o n a l A t t i t u d e S c a l e , the Hopelessness Questionnaire. 1/2  hours.  S c a l e , and the Automatic The e n t i r e procedure  The second  Thoughts  l a s t e d approximately 1  phase of the study i n v o l v e d the  c o l l e c t i o n of follow-up of d e p r e s s i o n s t a t u s , approximately 3 months a f t e r the I n i t i a l s e s s i o n .  This was  done by  m a i l i n g the Beck Depression Inventory to s u b j e c t s .  80  chapter  Dichotic listening  7:  This task was designed  task  to i n v e s t i g a t e whether the  i n v o l u n t a r y p r o c e s s i n g of i n f o r m a t i o n r e l a t e d t o d e p r e s s i o n d i f f e r s between depressed and nondepressed This paradigm was adapted from Bargh ( 1 9 8 2 ) MacLeod ( 1 9 8 6 ) . stories  Subjects  individuals. and Mathews and  were asked to shadow n e u t r a l  i n a d i c h o t i c l i s t e n i n g task while  simultaneously  being exposed to d e p r e s s i o n - r e l a t e d or p o s i t i v e words i n the unattended channel.  I t was assumed that the presence of the  unattended words would a t t r a c t p r o c e s s i n g r e s o u r c e s , a d i s r u p t i o n of ongoing t a s k s .  causing  T h i s d i s r u p t i o n was measured  by r e q u i r i n g s u b j e c t s t o , c o n c u r r e n t l y with the d i c h o t i c l i s t e n i n g task, d e t e c t a v i s u a l probe, the word "PRESS", presented  i n t e r m i t t e n t l y on a computer screen.  d e t e c t i o n l a t e n c i e s , then, were considered  The probe  as an index of  spare  p r o c e s s i n g resources  a f t e r the requirements of the  other  tasks had been met.  I t was hypothesized  presence of a d e p r e s s i v e of d e p r e s s i o n - r e l a t e d  that the  schema would f a c i l i t a t e  information.  processing  Thus, the p r e s e n t a t i o n  of d e p r e s s i o n - r e l a t e d words would be l e s s d i s r u p t i v e t o schematic depressed I n d i v i d u a l s than nondepressed nonschematlc  individuals.  Method Materials Stories. presented  Four  In T a b l e  were c o n s t r u c t e d not  s t o r i e s were c o n s t r u c t e d 1 o£ A p p e n d i x  t o be n e u t r a l  a r o u s e any a f f e c t t h a t  processing channel.  Each s t o r y was  unattended  adjectives.  second.  high  scores  1.58.  word  and  Richman  On a r a n g e  (1971). task  t o word  15  i n Table  3.  o f one word  of d e p r e s s i o n , from 1 t o 9  as  (high  the averaged  words was  8.11,  f o r the p o s i t i v e - c o n t e n t  whereas  words  o f words were r o u g h l y  was equated  from C a r r o l l ,  The d i s t r a c t o r words u s e d  were matched w i t h t h e t a r g e t  Davis,  i n the words  with  f r e q u e n c y and r a t i n g s of d e p r e s s i o n .  the  analyses  involved  the c o n f i r m a t i o n  the  d i s t r a c t o r s words were  The  on t h e b a s e s o f t h e i r  to depression),  f r e q u e n c y , w h i c h were t a k e n  recognition respect  ratings  and  a t the r a t e  of d e s c r i p t i v e n e s s  As w e l l , t h e two s e t s  for  60-61 w o r d s .  These a r e p r e s e n t e d  (1984).  lasted  o f words were p r e s e n t e d i n  f o r the d e p r e s s i o n - r e l a t e d  averaged  i n the unattended  15 d e p r e s s i o n - r e l a t e d  indicate relatedness  ratings the  sets  T h e s e words were s e l e c t e d  by Myers  they d i d  by a male r e a d e r ,  by a f e m a l e r e a d e r  or low r a t i n g s  provided  Two  so t h a t  have p o t e n t i a l l y a l t e r e d t h e  recorded  channel:  words were r e a d per  i n content,  25 s e c o n d s , and c o n t a i n e d  U n a t t e n d e d words.  positive  These n a r r a t i v e s t o r i e s  of t h e a f f e c t - l a d e n m a t e r i a l  approximately  the  may  I.  and t h e s e a r e  that  the target  Since and  Indeed matched, t h e p r o p e r t i e s o f  Table  3  stimulus  words  Depressiontarget abandoned apathetic beaten bleak despa i r i n g destitute downcast gloomy gr ieved miserable regretful remorseful suicidal tearful weary M SD  for Dichotlc  Freq  Dep  69 2 71 19 8 2 6 29 12 53 2 2 2 6 104 25.80 (32.6)  7.,81 7..75 8,,19 7.,85 8.,27 7.,89 8.,77 8.,04 8.,00 8,,39 8,,00 8..12 7,.85 8,.62 8,.15 8.11 ( .30)  Positive-target achieving 15 34 amusing bold 87 bubbly 6 17 carefree 86 capable 87 cheerful 91 delighted 28 dynamic fortunate 52 giggly 11 joyful 23 playful 29 respected 37 satisfied 133 M 49.07 SD  (38.21)  2. 08 1. 50 1. 65 1. 42 1. 46 1. 46 1. 56 1. 15 1. 54 1. 65 1. 58 1. 46 1. 46 1. 65 2. 12 1. 58 (.24)  Listening  Task  Depressiondistractor afflicted anguished burdened def i c i e n t deserted devasted dull forlorn gloomy guilty melancholy shattered sorry worthless wretched  Freq  Dep  17 4 2 4 52 10 54 3 29 44 28 42 285 20 21 41.00 (69.8)  7,.75 8,.46 8,.31 8,.04 8,.00 8,.08 8,.00 8,.27 8,.04 7,.62 7,.69 8,.12 7,.92 8,.00 7,.92 8,.01 (.23)  Positive-distractor carefree 17 contented 39 eager 159 encouraged 79 entertaining 20 lively 129 merry 97 optimistic 15 outgoing 6 refreshed 9 relaxed 42 robust 8 sociable 3 successful 236 wittv 4  1. 46 1. 73 1. 54 1. 27 1. 39 1. 39 1. 31 1. 69 1. 46 1. 69 2. 58 1. 42 1. 89 1. 92 1. 77 57.53 1. 63 (69.70)(.33)  Note. Freq = word frequency. Ratings taken from C a r r o l l , Davis, and Richman ( 1 9 7 1 ) . Dep = r a t i n g s of d e p r e s s i o n from a s c a l e from 1 to 9 where higher r a t i n g s denote a d j e c t i v e s h i g h l y d e s c r i p t i v e of d e p r e s s i o n . Ratings are taken from Myers ( 1 9 8 4 ) .  83 the t a r g e t words w i l l be d i s c u s s e d recognition  i n the context of the  task.  Recognition  test.  The r e c o g n i t i o n t e s t i s presented i n  Table 2 of Appendix I. The t e s t contained  the two s e t s of  t a r g e t words, as well as two sets of d i s t r a c t o r words, listed  i n Table 3.  The d i s t r a c t o r words were s e l e c t e d so  that they were matched descrlptiveness  i n frequency and r a t i n g s of  of depression  with the c r i t i c a l  list.  To  confirm  that the c r i t i c a l and d i s t r a c t o r l i s t s had the  desired  p r o p e r t i e s , a four between-groups  target, depresslon-distractor,  (depression-  p o s i t i v e - t a r g e t , and  p o s i t i v e - d i s t r a c t o r ) MANOVA was conducted with word frequency and depression dependent measures.  descrlptiveness  r a t i n g s as  The s i g n i f i c a n t MANOVA  (Wilk's  lambda(6,110) = .0068, p_ < .001) was followed u n i v a r i a t e ANOVAs for each dependent v a r i a b l e .  with The  n o n s i g n i f i c a n t ANOVA f o r word frequency, F(3,56) = .86, p_ > .05, suggests that the four types of words d i d not d i f f e r s i g n i f i c a n t l y with respect  t o t h e i r average f r e q u e n c i e s .  expected, the groups of words were d i s t i n g u i s h a b l e respect  t o t h e i r r a t i n g s of depression,  < .001. Tukey comparisons showed that  As  with  F(3,56) = 2690.54, p_ the depression-  t a r g e t words had s i g n i f i c a n t l y higher r a t i n g s of depression than the p o s i t i v e - t a r g e t words, g(4,56) = 90.85, p. < .05. However,  the two depression  l i s t s d i d not d i f f e r  s i g n i f i c a n t l y from each other with respect of d e p r e s s i o n ,  to t h e i r r a t i n g s  g(4,56) = 1.39, p_> .05. Likewise, the two  p o s i t i v e l i s t s d i d not d i f f e r s i g n i f i c a n t l y with respect to t h e i r r a t i n g s of d e p r e s s i o n , g(4,56) Reaction time probes.  = .71, p. > .05.  The p r e s e n t a t i o n of the word  "PRESS" served as a r e a c t i o n time  probe.  Procedure Subjects were i n s t r u c t e d as f o l l o w s : For t h i s task, you w i l l be asked earphones.  you can without  Try to do t h i s as q u i c k l y as  making mistakes.  might be s a i d on the l e f t ear.  Ignore  the word "PRESS"  Whenever you see the word  "PRESS", press t h i s button keyboard).  screen.  w i l l disappear, and  w i l l appear i n s t e a d .  take  Most of the time, a  appear on the center of the  Sometimes, the "+"  anything t h a t  At the same time,  a look a t the computer screen. +  these  Your task i s to repeat aloud e v e r y t h i n g you  hear i n your r i g h t ear.  •i H vill  to put on  (a key on a computer  Try to do t h i s as q u i c k l y as you can  but  don't f o r g e t , the most Important t h i n g to do i s to repeat whatever i s being s a i d there any questions?  In your r i g h t ear.  Are  Let's s t a r t with some p r a c t i c e  stories. The  s t o r i e s were presented  i n the r i g h t hand channel,  whereas the s e t s of words appeared  i n the l e f t hand channel.  To ensure t h a t the volume l e v e l s f o r both channels were roughly e q u i v a l e n t , the experimenter  matched the volumes of  each channel  by l i s t e n i n g to each i n t u r n , then switching  the channels  to a v o i d any r i g h t ear b i a s .  The  unattended  85 words presented  i n the l e f t hand channel are processed  the r i g h t c e r e b r a l hemisphere.  I t has  by  been suggested t h a t  the r i g h t c e r e b r a l hemisphere p l a y s a s a l i e n t r o l e i n the processing  of a f f e c t i v e d i s o r d e r s  ( c f . Bryden & Ley,  1983;  Heilman, Watson, & Bowers, 1983). Two  p r a c t i c e s t o r i e s were g i v e n ,  were presented  i n the unattended channel.  -stories followed.  Two  the d e p r e s s i o n - r e l a t e d while  i n which n e u t r a l words  the other  two  of the  The  four t a r g e t  four s t o r i e s were paired  words i n the unattended  with  channel,  s t o r i e s were p a i r e d with the p o s i t i v e  words. The  presentation  presentation  of the words was  of the s t o r i e s .  i n synchrony with  T h i s was  achieved  experimenter s t a r t i n g the tape r e c o r d e r program at the same time.  and  presented  for each s t o r y .  The  followed.  of f i v e n e u t r a l words.  Thus, the c r i t i c a l  s t o r y ' s onset and The  the computer  list  The  Introductory  i n t r o d u c t o r y phase  c o n s i s t e d of 2 seconds of s i l e n c e , followed presentation  the  To allow s u b j e c t s to adequately  o r i e n t themselves to each s t o r y , a 7 second phase was  by  the  by  the  c r i t i c a l words  began 7 seconds a f t e r the  ended 3 seconds before  the s t o r y f i n i s h e d .  i n i t i a l p r e s e n t a t i o n of the n e u t r a l words i n the  Introductory  phase ensured that the c r i t i c a l  words did  not  a t t r a c t undue a t t e n t i o n by emerging from a s i l e n t background. All The  order  p o s s i b l e orders  of stimulus  of s t o r y p r e s e n t a t i o n was  p r e s e n t a t i o n were used. arranged i n t o four  86 d i f f e r e n t sequences, with each s t o r y p a i r e d with both types of  words.  T h i s arrangement  sequences.  created e i g h t  possible  The orders were arranged s e q u e n t i a l l y on a  where the f i r s t  s u b j e c t r e c e i v e d the f i r s t  list,  order, the second  s u b j e c t r e c e i v e d the second order and so on, u n t i l the was exhausted. first  list  At t h i s p o i n t , the next s u b j e c t r e c e i v e d the  order and so on.  As w e l l , the sequence of  p r e s e n t a t i o n of the unattended words was determined, and was d i f f e r e n t  randomly  f o r each s t o r y .  Concurrent with the d i c h o t i c l i s t e n i n g task, s u b j e c t s were r e q u i r e d to perform a simple r e a c t i o n time task. were asked to f i x a t e on a "+", computer s c r e e n . the  They  presented c e n t r a l l y on a  S u b j e c t s were asked to respond whenever  word "PRESS" r e p l a c e d the "+"  key on the computer  by p r e s s i n g a response  keyboard.  Three probes - the word "PRESS" - were presented f o r each s t o r y .  The p r e s e n t a t i o n of a probe c o i n c i d e d with the  p r e s e n t a t i o n of a c r i t i c a l word i n the unattended channel. Since the probes appeared during the p r e s e n t a t i o n of the c r i t i c a l words, no probe stimulus appeared i n the f i r s t 7 seconds or the l a s t  3 seconds of each s t o r y .  15 seconds were d i v i d e d  The remaining  i n t o three blocks of f i v e ; a probe  could appear anywhere w i t h i n t h i s I n t e r v a l , with the c o n s t r a i n t t h a t no two probes appeared w i t h i n 3 seconds of each other. The experimenter l i s t e n e d to each shadowed s t o r y with Its  s c r i p t a t hand.  The experimenter kept track of the  87  number and type of shadowing e r r o r s by c r o s s i n g o f f a l l missed or misstated word on the s c r i p t .  The probe d e t e c t i o n  l a t e n c i e s were recorded by the computer. Subjects were then given the r e c o g n i t i o n t e s t .  They  were i n s t r u c t e d : In the l e f t  hand channel that you were supposed to  ignore, there were some words presented on that channel.  Here i s a l i s t  words on that channel? guess.  of words.  Were any of these  I f you are unsure, take a  Don't be a f r a i d to guess and don't spend too  much time on any one word. Hypotheses (a)  The presence of the d e p r e s s i v e schema would  processing of d e p r e s s i o n - r e l a t e d s t i m u l i .  Thus,  facilitate currently  depressed I n d i v i d u a l s would take l e s s resources t o process unattended d e p r e s s i o n words, ongoing t a s k s .  l e a d i n g to l e s s  I n t e r f e r e n c e of  Compared to nondepressed nonscheraatic  i n d i v i d u a l s , c u r r e n t l y depressed s u b j e c t s would have shorter probe d e t e c t i o n l a t e n c i e s and fewer shadowing  e r r o r s during  s t o r i e s with unattended d e p r e s s i o n - r e l a t e d words.  An  opposite p a t t e r n was expected f o r nondepressed nonschematic i n d i v i d u a l s f o r the p o s i t i v e unattended words. (b)  Depressive automatic processes are v u l n e r a b i l i t y  markers.  Thus, the p a t t e r n Of performance of remitted  depressed i n d i v i d u a l s would resemble those of the c u r r e n t l y depressed  subjects.  (c)  The  unattended m a t e r i a l i s processed  unconsciously.  A l l groups of s u b j e c t s would show chance performance on  the  r e c o g n i t i o n task. Results Analyses The times  dependent measures were averaged probe r e a c t i o n  and  variance  the number of shadowing e r r o r s . involved a two-factor  of groups  (CDG,  word types  RDG,  NDG)  The  a n a l y s i s of  mixed design, which c o n s i s t e d  as a between-subjects f a c t o r ,  and  (depression, p o s i t i v e ) as a w i t h i n - s u b j e c t s  factor. R e c o g n i t i o n performance was number of f a l s e alarms  scored by counting  the  ( i n c o r r e c t endorsements) and  ( c o r r e c t endorsements).  The  hits  a n a l y s i s of v a r i a n c e design f o r  the r e c o g n i t i o n task  i s a t h r e e - f a c t o r mixed one, c o n s i s t i n g  of groups (CDG,  NDP),  and  RDG,  response types  (hits,  word types  (depression, p o s i t i v e )  f a l s e alarms).  i s between-subjects, while the l a s t two  The  first  factor  f a c t o r s are w i t h i n -  subjects. Probe r e a c t i o n time. presented  in Table  The  probe r e a c t i o n times  are  4, whereas the r e s u l t s of the a n a l y s i s of  v a r i a n c e are summarized  i n Table  1 of Appendix J .  The  a n a l y s i s of v a r i a n c e showed t h a t there were n o n s i g n i f i c a n t main e f f e c t s f o r word types, F ( l , 5 7 ) = .08, p_ > .10,  and  groups; F(2,57) = 2.38,  a  significant  p_ > .05.  However, there was  i n t e r a c t i o n between groups and word types,  89  Table 4 Detection Latencies Msecs  from the D i c h o t l c L i s t e n i n g Task l n  1  CDG Content  RDG  NDG  Condition  Depression  M SD  506.75 (149.06)  486.85 (145.92)  476.40 (250.21)  Positive  M 575.80 SD - ( 2 7 6 . 9 7 )  495.80 (169.34)  378.50 (64.11)  Note. CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group. NDG = Nondepressed group.  90 F(2,57) = 4.17, Figure  p_ < .05.  This i n t e r a c t i o n i s i l l u s t r a t e d in  1.  In l i g h t of the s i g n i f i c a n t comparisons  Interaction  effect,  were conducted to examine the p r e d i c t i o n s  the f i r s t and second hypotheses.  from  To r e i t e r a t e , i t Was  hypothesized that the two depressed groups would have quicker probe d e t e c t i o n l a t e n c i e s a s s o c i a t e d with the depression-content words, while nondepressed show the reverse p a t t e r n .  s u b j e c t s would  Thus, within-groups  comparisons  conducted across the two word types were warranted. comparisons  showed that both depressed groups d i d not  d i f f e r e n t i a l l y process across the two word types:  g(3,57) = 2.36, p. > .05; RDG: Tukey's t e s t f o r the NDG,  s i g n i f i c a n t at the p = .10  CDG:  g(3,57) = .31, p_ > .05.  g(3,57) = 3.34,  s t a t i s t i c a l s i g n i f i c a n c e at the p_ = .05  nondepressed  Tukey  j u s t missed l e v e l but  was  l e v e l , suggesting that  s u b j e c t s had s l i g h t l y s h o r t e r  detection  l a t e n c i e s a s s o c i a t e d with the p o s i t i v e - c o n t e n t than the depression-content words. Correlation analysis. depressed groups appeared times to the v i s u a l probe. slowed r e a c t i o n times may  As seen l n F i g u r e 1, the  two  to have o v e r a l l longer r e a c t i o n The p o s s i b i l i t y e x i s t s t h a t be a t t r i b u t e d to the older ages  a s s o c i a t e d with the two depressed groups  ( c f . A l b e r t , 1981),  or as a f u n c t i o n of the s e v e r i t y of d e p r e s s i o n ( c f . Freldman,  1964).  To t e s t f o r t h i s p o s s i b i l i t y ,  Pearson-  product moment c o r r e l a t i o n c o e f f i c i e n t s were computed f o r  91  Figure 1. Detection latencies from the dichotic listening task.  -•— Currently depressed group  600-  A  Remitted depressed group  •  Nondepressed group  o  LU  co >o z  500 -  LU  400  300  Depression  Positive  CONTENT CONDITION  92 the o v e r a l l r e a c t i o n times with BDI scores and age f o r a l l s u b j e c t s and f o r the c l i n i c a l  s u b j e c t s alone.  values were of an acceptable magnitude.  None of the  For a l l s u b j e c t s ,  the c o r r e l a t i o n c o e f f i c i e n t s were .25 and .21 (both p_ > .05, df  = 58) f o r , r e s p e c t i v e l y , r e a c t i o n times with age and  r e a c t i o n times with BDI s c o r e s .  For the a n a l y s i s with the  two depressed groups alone, the c o r r e l a t i o n s were even lower:  .12 ( r e a c t i o n time with age), and .10 ( r e a c t i o n  with BDI).  Thus, i t i s u n l i k e l y that the slowed  time  reaction  times of the two depressed groups were due to i n c r e a s e d age or  s e v e r i t y of depression, but perhaps  are more l i k e l y due  to d e b i l i t a t i n g e f f e c t of the presence of p o s i t i v e words In the unattended  channel.  Shadowing performance.  The shadowing performance f o r  each group Is summarized i n Table 5, whereas the r e s u l t s of the a n a l y s i s of variance are presented i n Table 2 of Appendix J .  Of c e n t r a l i n t e r e s t , the a n a l y s i s of v a r i a n c e  showed a n o n s i g n i f i c a n t group x word type  interaction  e f f e c t , F ( 2 , 5 7 ) = .30, p_ > .10, suggesting that t h i s measure was i n s e n s i t i v e measure of the d e p r e s s i v e schematic R e c o g n i t i o n task performance. r e c o g n i t i o n h i t rate are presented  effect.  The data f o r the i n Table 6.  Despite the  encouragement t o guess, s u b j e c t s were r e l u c t a n t to do so, as evidenced by a low o v e r a l l of  a p o s s i b l e 60 items).  "yes" response  rate  (M = 1.51 out  This r e s u l t substantiates  s u b j e c t s ' c l a i m s that they d i d not hear the words In the unattended  channel.  Table 5 Mean Number of Shadowing  Errors  CDG Content  RDG  NDG  Condition  Depression  M SD  .45 (0.95)  .45 (0.85)  1.20 (2.26)  Positive  M SD  .45 (0.51)  .85 (1.27)  1.15 (1.66)  Note. CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group NDG = Nondepressed group.  Table 6 Mean Number of word3 RecognW.eri  CDG Content  RDG  NDG  Condition  Hits Depression  M SD  1.70 (3.05)  1.35 (2.01)  3.60 (3.54)  Positive  M SD  .95 (2.06)  .60 (1.14)  2.20 (3.44)  False  positives  Depression  M SD  1.15 (2.34)  .40 ( .68)  2.24 (3.4.S)  Positive  M SD  1.05 (2.14)  .50 (1.10)  2.20 (3.41)  Note . CDG = C u r r e n t l y depressed group, RDG = Remitted depressed group. NDG = Nondepressed group.  95  The  a n a l y s i s of v a r i a n c e ,  listed  3, produced s e v e r a l s i g n i f i c a n t s i g n i f i c a n t main e f f e c t  i n Appendix J - Table  effects.  First,  for groups, F(2,57)  However, Tukey t e s t s showed no s i g n i f i c a n t comparisons: RDG:  >  CDG  g(3,57) =  vs. NDG:  .71,  p_ >  g(3,57)  .05;  RDG  = 4.14,  NDG:  a  p_ <  .05.  p_ > .05; CDG  vs.  groupwise  = 1.90,  vs.  there was  g ( 3 , 5 7 ) = 2.64,  p_  .05.  Of more t h e o r e t i c a l ; i n t e r e s t , there was main e f f e c t  a significant-  f o r response, F ( l , 5 7 ) = 14.01, p_ < .001,  with  s u b j e c t s making more h i t s than f a l s e alarms (3.46 vs. Thus, s u b j e c t s words. other  had  above chance r e c o g n i t i o n of the  However, no group appeared to be  presented  b e t t e r than  group at c o r r e c t l y r e c o g n i z i n g the presented  2.48).  any  words, as  i n d i c a t e d by the n o n s i g n i f i c a n t group x response Interaction,  (F(2,57) = .86, p> > .05), and  the  n o n s i g n i f i c a n t group x response x content i n t e r a c t i o n (F( 2, 57 ) = . 37,  p_ > ,05) . Summary  The  first  depression  hypothesis  s t a t e s that the presence of a  schema would f a c i l i t a t e  the p r o c e s s i n g  unattended d e p r e s s i o n - r e l a t e d s t i m u l i . first  hypothesis,  Contrary  n e i t h e r c u r r e n t l y depressed nor  depressed s u b j e c t s showed quicker  in their processing  the  to the remitted  probe d e t e c t i o n l a t e n c i e s  when d e p r e s s i o n - r e l a t e d words were presented unattended channel.  of  Rather, they showed an of the s t i m u l i :  i n the even-handedness  they had  similar  d e t e c t i o n l a t e n c i e s a s s o c i a t e d with both the d e p r e s s i o n -  and  positive-content s t i m u l i .  In c o n t r a s t , nondepressed  s u b j e c t s d i f f e r e n t i a l l y process p_ = .10  level,  these  the two  s u b j e c t s reacted to the probe  when p o s i t i v e words were presented channel,  word c o n d i t i o n s .  i n the  i n d i c a t o r of d e p r e s s i v e  words,  not a s e n s i t i v e  processing bias.  p a t t e r n of e r r o r s across  quicker  unattended  compared to the depression-content  shadowing performance, i n g e n e r a l , was  At  That i s , the  the three groups was  highly  similar. The  second hypothesis  processes,  as assessed  s t a t e s that d e p r e s s i v e  by the d i c h o t l c l i s t e n i n g  c o n s t i t u t e v u l n e r a b i l i t y markers. hypothesis,  In support  the p a t t e r n of p r o c e s s i n g of the  depressed s u b j e c t s was  automatic task,  of the second remitted  more s i m i l a r to the c u r r e n t l y  depressed s u b j e c t s than the nondepressed s u b j e c t s . The  t h i r d hypothesis  s t a t e s that the p r o c e s s i n g of the  unattended m a t e r i a l i s nonconscious. was  not supported.  Despite  The  third  hypothesis  s u b j e c t s ' s u b j e c t i v e r e p o r t s of  not hearing the unattended words, they showed above chance performance on the r e c o g n i t i o n task.  chapter  8: v i s u a l Probe Task  T h i s task, adapted from MacLeod, Mathews, and (1986),  was  designed  attention.  to measure the d i s t r i b u t i o n of v i s u a l  P a i r s of words were presented  s c r e e n , one appearing the other appearing  i n the lower  d e p r e s s i o n - n e u t r a l , and  "+"  h a l f of the s c r e e n .  and There  neutral-neutral,  positive-neutral.  to read the top word aloud.  a secondary  on a computer  i n the upper h a l f of the screen,  were three types of word p a i r s :  asked  Tata  Subjects were  Subjects were a l s o given  r e a c t i o n time task of responding  to a probe, a  which appeared on e i t h e r l o c a t i o n of the words, as  q u i c k l y as p o s s i b l e . The  d i s t r i b u t i o n of v i s u a l a t t e n t i o n i s i n f e r r e d by the  p a t t e r n of d e t e c t i o n l a t e n c i e s of the probes.  Subjects have  s h o r t e r d e t e c t i o n l a t e n c i e s f o r t a r g e t s that are i n t h e i r a t t e n t i o n a l f i e l d s , and take longer If t h e i r a t t e n t i o n had been drawn elsewhere schematic  (Navon & Margal1t,  1983).  Depressed  i n d i v i d u a l s , t h e o r e t i c a l l y , have a p r o c e s s i n g b i a s  t h a t f a v o r s the encoding Depressed schematic  of d e p r e s s i o n - r e l a t e d s t i m u l i .  i n d i v i d u a l s , r e l a t i v e to nondepressed  nonschematic i n d i v i d u a l s , are hypothesized a t t e n t i o n towards the depression-words, d e t e c t i o n l a t e n c i e s f o r probes appearing such s t i m u l i .  to s h i f t  resulting  their  i n reduced  i n the v i c i n i t y  This e f f e c t can be explained by examining the  sample t r i a l s i n which the d e p r e s s i o n words are presented the lower  of  part of the s c r e e n .  in  Subjects are r e q u i r e d to read  the top word aloud, thus d i v e r t i n g t h e i r a t t e n t i o n to the  top words.  However, the  presence of the  word i n the  bottom h a l f of the  depression-related  screen would lead depressed  I n d i v i d u a l to s h i f t t h e i r a t t e n t i o n toward the location.  Since t h e i r a t t e n t i o n had  bottom l o c a t i o n of the Individuals the  been drawn to  the  screen, depressed schematic  would be quicker  bottom h a l f of the  in the  bottom  to detect  probes presented  in  screen compared to probes presented  upper part of the  screen. Method  Materials Three s e t s of words p a i r s were presented. listed  i n Table 7, were:  n e u t r a l , and each s e t .  neutral-neutral.  selected  There were 14 word p a i r s i n  task.  depression-related  and  positive adjectives  f o r , r e s p e c t i v e l y , t h e i r high and  descrlptiveness  low  were  ratings  of  of d e p r e s s i o n , as provided by Cheung (1987).  As w e l l , there was respect  positive-  None of the words used i n the d i c h o t l c l i s t e n i n g  task appeared i n t h i s The  depression-neutral,  These,  an attempt to equate the  to word length  lists  with  (number of l e t t e r s in a word) and  word frequency, as both have been shown to a f f e c t r e a c t i o n times to words (e.g., Morton, 1969;  Scuberth, Spoehr, &  Lane, 1981). Analyses confirmed that these sets of words had desired  properties.  F i r s t , an a n a l y s i s of variance  that the d e p r e s s i o n - r e l a t e d  words had  r a t i n g s o£ depression than the  the showed  s i g n i f i c a n t l y higher  p o s i t i v e words, F ( i , 2 6 )  =  99 Table 7 Stimulus  Words f o r V i s u a l Probe Task  Depressloncontent  WL  blue 4 defeated 8 depressed 9 8 desolate despondent 10 6 dismal downcast 8 dreary 6 1i f e l e s s 8 mournful 8 sad 3 sluggish 8 sorrowful 9 8 dejected M 7.36 SD 1.95 Pos i t i v e - c o n t e n t 9 assertive attentive 9 8 cheerful 9 conf ident 7 dynamic 6 gi fted 5 happy industrious 11 5 loved 10 product ive 6 rested 6 secure 8 spirited 8 thr i v l n g M 7 .64 SD 1 .86 Neutral 6 abroad 10 accustomed 7 evasive 8 accented 7 allowed 5 corny 7 cramped 5 curly 6 guided  WF  D  1071 4.13 96 4.24 14 4.96 25 4.31 2 4.13 22 ,4.09 6 4.27 19 3.93 17 4.16 16 4.20 309 4 . 58 6 3.67 13 4.16 4 4 . 56 115.7 4.24 286.5 .32 7 10 87 37 28 16 774 8 347 45 88 75 13 29 111.7 209.6 155 55 2 124 278 4 14 44 46  1.20 1. 09 1.04 1.07 1.09 1.09 1.02 1.11 1.13 1.09 1. 38 1.16 1.04 1.12 1.12 .09  Matched Neutral  WL  WF  tall mounted academic gradual 1ightened dainty cluttered braided barefoot guessing dressed masculine feminine shaven  4 848 7 132 8 19 7 26 2 9 6 22 6 9 7 17 8 17 7 19 7 310 9 7 8 12 6 4 7 .14 103.1 1 .61 229 . 8 Matched n e u t r a l 6 cluttered 9 Immigrant 9 11 accompanied 11 76 motionless 10 43 7 27 focused hushed 6 17 6 871 moving lengthened 10 10 nearby 6 335 addressed 9 49 greeted 7 70 hurrying 9 69 7 14 hunched loosened 8 26 116.0 8 .14 1 .66 232.8 Matched neutal 5 brief 7 neutral 5 jumbo 5 shiny dressed 7 6 shaven lending 7 junior 6 5 urban  t a b l e continued  160 53 3 123 310 4 12 44 50  on next page . . .  100 hidden indoor lean quenched loudly  M SD  6 7 4 8 6 6.57 1.50  210 10 99 3 124 83.43 85.90  landed pauslng mild squeaky recal1  6 7 4 7 6 5.93 1.00  178 11 115 3 138 86.00 89.78  Note. WL = word length (number of l e t t e r s i n a word) WF = word frequency. These r a t i n g s are from C a r r o l l , Davis, and Richman (1971). D = r a t i n g s of depression on a s c a l e from 1 t o 5 where higher r a t i n g s are h i g h l y d e s c i p t i v e of d e p r e s s i o n . These r a t i n g s are taken from Cheung ( 1 9 8 7 ) .  101 1338.21, p_ < ,001. suggested another  Furthermore, analyses of variance  that the l i s t s were not d i s t i n g u i s h a b l e from one  i n e i t h e r word l e n g t h , F(5,78) = 1.78, p. > .10, or  word frequency,  F(5, 78) = . 33, p_ > .10.  Procedure Subjects were given the f o l l o w i n g s e t of i n s t r u c t i o n s , which were modified from those  i n MacLeod et a l . (1986):  For t h i s task, you are going t o see words presented  on the screen i n p a i r s .  One word  will  appear j u s t above the center of the screen and one j u s t below. appears.  Read the top word aloud as soon as i t  Sometimes when the two words disappear, a  s m a l l "+" w i l l appear e i t h e r  i n the area where the  top word appeared or where the bottom word appeared. When you see the "+", press t h i s button  [a response  key on a computer keyboard] as q u i c k l y as you can. Are  there any questions?  Subjects were f i r s t given a s e t of p r a c t i c e  trials  c o n s i s t i n g of 10 p a i r s of n e u t r a l words and three  probes.  The three s e t s of 14 word p a i r s were presented producing trials  a t o t a l of 126 t r i a l s .  contained probes,  word s e t .  Forty-two  thrice,  of the 126  with 14 probes appearing  f o r each  To avoid any p o t e n t i a l order e f f e c t , each s u b j e c t  r e c e i v e d a d i f f e r e n t sequence of the p r e s e n t a t i o n of the word p a i r s . The s t i m u l i were presented presented  on a microcomputer.  A dot,  c e n t r a l l y on the screen, served as a f i x a t i o n  102 point.  The dot r e m a i n e d on the s c r e e n f o r 500 msec.  dot then disappeared, and the word p a i r was word appeared j u s t below.  j u s t above the center The words remained  The  presented.  of the screen and  f o r 500 msec.  one  On t r i a l s  c o n t a i n i n g the probe, the f i x a t i o n p o i n t reappeared. probed t r i a l s ,  the "+"  the t e r m i n a t i o n the screen  the  On  The probe remained  the s u b j e c t responded  a computer t e r m i n a l .  not  appeared approximately 25 msec a f t e r  of the word d i s p l a y .  until  One  Detection  on  by p r e s s i n g a key on  l a t e n c i e s were recorded  by  microcomputer.  Hypotheses (a)  Depressed  i n d i v i d u a l s , compared to  nondepressed  i n d i v i d u a l s , would have shorter response l a t e n c i e s to probes that were preceded by d e p r e s s i o n - r e l a t e d vicinity. longer  S i m i l a r l y , depressed i n d i v i d u a l s would have  response l a t e n c i e s to probes when preceded  depression-related (b)  words In the  Nondepressed  by  words presented i n a d i f f e r e n t l o c a t i o n . i n d i v i d u a l s , compared to depressed  i n d i v i d u a l s , would have shorter response l a t e n c i e s to probes that were preceded by p o s i t i v e words i n the Likewise,  nondepressed  vicinity.  I n d i v i d u a l s would have  longer  v response l a t e n c i e s to probes that were preceded by p o s i t i v e words i n the (c)  vicinity.  The p a t t e r n of p r o c e s s i n g  information  f o r the r e m i t t e d  of the  depression-related  subjects would resemble  the c u r r e n t l y depressed s u b j e c t s .  that of  103  Results AnalysIs The  d e p e n d e n t measure was  latency.  The  analysis  mixed d e s i g n , word, t y p e (upper, first  (depression,  were  -Missing  data  of  and  f a c t o r was  factors  of  to  the the  were n o t (1982),  target  (upper,  were 12  stimuli.  four-factor RDG,  NDG),  word p o s i t i o n  lower).  the  other  The three  that  the  target  For  the  the  f o r any  a l l possible possible  ( 1 . 2 4 % or  these missing  possible  (three  types  words x  two  presentation  of  program r a n d o m l y d e t e r m i n e d  words and  total  presented  condition.  of  computer  of t h e  group average t o  there  p o s i t i o n s of  types  generate  percentage  a  (CDG,  between-subjects, while  Thus, i t i s p o s s i b l e failed  of g r o u p s  detection  within-subjects.  probe p o s i t i o n )  position  Involved  probe p o s i t i o n  word x two  each t a r g e t ,  probe  p o s i t i v e , n e u t r a l ) , and  each s u b j e c t ,  target  variance  which c o n s i s t e d  lower),  For  o£  averaged  data  which t h a t  p o s i t i o n of the  one  subject,  t y p e s of trials  12/960).  stimuli. across  As  were e s t i m a t e d subject  the  the probe.  program A  small  a l l subjects  suggested  by  by  the  belonged  taking f o r the  Kirk  missing  104  Detection  latencies  The d e t e c t i o n l a t e n c i e s whereas the r e s u l t s presented  i n Table 8,  of the a n a l y s i s of v a r i a n c e are  i n Appendix K.  Contrary to p r e d i c t i o n s ,  x word type x word p o s i t i o n effect  are presented  x probe p o s i t i o n  the group  interaction  was not s i g n i f i c a n t , F(4,114) = 1,14, p_ > ,10.  However, there was a s i g n i f i c a n t main e f f e c t f o r groups,  F(2,57) = 4.59, p_ < .05. However, Tukey  showed no s i g n i f i c a n t  groupwise comparisons:  tests  CDG vs. NDG:  500.03 v s . 395.10 msec, g(3,57) = 1. 38, p. > .05; CDG v s . RDG:  500.03 v s . 469.87, g ( 3 , 5 7 ) = .40, p_>  NDG:  469.87 v s . 395.10, g ( 3 , 5 7 ) = .98, p_ > .05.  As expected,  t h e r e was a main e f f e c t  .05; RDG v s .  of probe  position,  F ( l , 5 7 ) = 34.53, p_ < .001, with s h o r t e r l a t e n c i e s f o r d e t e c t i n g the probe when presented  on the upper part r a t h e r  than the bottom part of the screen (415.26 v s . 484.52 msec), in addition,  there was a s i g n i f i c a n t content x word  Interaction effect, effects  F(2,114) = 3.33, p_ < .05. No other  were s i g n i f i c a n t . Summary  (  The  position  critical  Interaction effect  s t a t i s t i c a l significance.  to reach  T h i s f a i l u r e may be due to the  r e l a t i v e l y small sample s i z e . be the case.  failed  However, t h i s  i s unlikely to  Using an even smaller sample s i z e  (n = 16 f o r  each experimental group), MacLeod e t a l , (1986) used a similar  paradigm t o demonstrate a t t e n t i v e  samples of anxious  p a t i e n t s and normal  biases i n t h e i r  controls.  105 Table 8 Mean Probe Detection L a t e n c i e s  CDG  In Msec  RDG  NDG  Word C o n d i t i o n 1  1  BU 1  UU  UB  BU  BB  UU  UB  BJJ  BB  Depression M 438 520 422 533 SD 143 133 127 167  374 540 391 512 68 220 60 119  369 422 393 421 75 107 85 76  Positive M 433 533 486 576 SD 108 264 181 245  411 450 465 470 95 169 106 121  380 407 403 386 81 94 150 70  Neutral M 406 520 489 540 SD 120 163 202 217  442 521 428 510 155 147 109 145  385 437 361 424 75 110 68 62  Note. CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group. NDG = Nondepressed group. UU = t a r g e t word In top p o s i t i o n followed by UB = t a r g e t word i n top p o s i t i o n followed by BU = t a r g e t word i n bottom p o s i t i o n followed BB = t a r g e t word i n bottom p o s i t i o n followed probe.  top probe. bottom probe. by top probe. by bottom  106 The due  failure  to reach s t a t i s t i c a l s i g n i f i c a n c e may be  to the large v a r i a b i l i t y a s s o c i a t e d with the c u r r e n t l y  depressed group.  Table 8 shows the standard d e v i a t i o n s  a c r o s s the v a r i o u s c o n d i t i o n s ranged nondepressed  group's data, and ranged  r e m i t t e d depressed group's data. group's  from 70 to 150 f o r the from 60 to 155 f o r the  The c u r r e n t l y depressed  standard d e v i a t i o n s , which ranged  from 108 to 245,  r e p r e s e n t e d f a r more v a r i a b i l i t y than the other two groups. T h i s l a r g e v a r i a b i l i t y may simply r e f l e c t of  the h e t e r o g e n e i t y  the c u r r r e n t l y depressed s u b j e c t s themselves.  That i s ,  these s u b j e c t s came from s e v e r a l p s y c h i a t r i s t s who among themselves, may a t t r a c t d i f f e r e n t p a t i e n t populations and may have used d i f f e r e n t treatments.  This hypothesis seems  plausible  small v a r i a b i l i t y  i n l i g h t of the r e l a t i v e l y  a s s o c i a t e d with the data from the r e m i t t e d depressed s u b j e c t s , of which the m a j o r i t y were seen and t r e a t e d by one psychiatrist.  I t i s suggested that any s t u d i e s c o n s i d e r i n g  u s i n g t h i s paradigm variability  with depressed samples aim to reduce the  of the s u b j e c t groups.  107 Chapter This (1985),  task, adapted  Implicit from  contrasted implicit  depression-related implicit  explicit  Shiraamura,  explicit  information.  and i n d e p e n d e n t  Memory Task  Graf, with  memorial p r o c e s s e s  automatic  noted  9:  and s q u i r e  memory f o r  As d i s c u s s e d  are considered  of conscious  earlier,  t o be  relatively  awareness,  memory r e q u i r e s e l a b o r a t i v e p r o c e s s e s .  p r e v i o u s l y that the l i t e r a t u r e  inconsistent explicit  results  whereas I t was  has, a t best,  found  f o r d e p r e s s i v e memorial b i a s e s u s i n g  memory t a s k s .  However, I h y p o t h e s i z e  promising  research strategies  automatic  processes.  l i e l n those  t h a t more  involving  I t i s , therefore, hypothesized  memorial b i a s e s f o r i n f o r m a t i o n r e l a t e d depressed  schematic  individuals  would  implicit,  b u t n o t i n an e x p l i c i t ,  that  to depression i n  be e v i d e n t  i n an  memory t a s k .  Method Materials Four  content  category, and  t h e r e were f i v e  the exemplars  Happiness  (joyful,  Depression Flowers  latter  exemplars.  (presented  Within  labels  Inside the parentheses)  energetic, contented,  sunflower,  each  The c a t e g o r y  (hopeless, lethargy, t i r e d ,  (lilac,  Diseases  c a t e g o r i e s were u s e d .  marigold,  smiling,  lonely,  were:  friendly),  indifferent),  s n a p d r a g o n , p o p p y ) , and  (malaria, f l u , diabetes, a r t h r i t i s , leprosy).  two word t y p e s  respectively,  positive  were s e l e c t e d  as t h e y  have,  and n e g a t i v e a f f e c t i v e  but a r e n o t s p e c i f i c a l l y  related  The  to depression  associations, i n content.  108 The  i n c l u s i o n o£ these a f f e c t - l a d e n words Is to counter the  p o s s i b i l i t y t h a t any memorial biases f o r the depression and the p o s i t i v e words could be s o l e l y a t t r i b u t a b l e to the r o l e of a f f e c t . The  stimulus words were drawn from two sources.  Exemplars f o r the Flower and Disease c a t e g o r i e s came from B a t t l g and Montague (1969).  These i n v e s t i g a t o r s c o l l e c t e d  norms from 442 s u b j e c t s on the frequency exemplars f o r a number of c a t e g o r i e s .  of producing  To avoid c e i l i n g and  f l o o r e f f e c t s on the category p r o d u c t i o n tasks, exemplars were chosen that were n e i t h e r f r e q u e n t l y nor I n f r e q u e n t l y produced.  Based on the 442 s u b j e c t s , the s e l e c t e d exemplars  had an o v e r a l l p r o d u c t i o n frequency of 34.2 (SD = 12.82) with a range of 17 to 54.  The Flower exemplars had an  o v e r a l l average production frequency of 29.2 (S_D = 11.26) with a range of 17 to 45, whereas the Disease exemplars had an o v e r a l l average production frequency  of 39.2 (SD = 13.45)  with a range of 24 to 54. Exemplars f o r the Depression  and Happiness c a t e g o r i e s  came from 18 s u b j e c t s , who were u n i v e r s i t y students.  These  s u b j e c t s were g i v e n the i n s t r u c t i o n s : The  purpose of t h i s e x e r c i s e i s to f i n d out what  words or a d j e c t i v e s people  u s u a l l y give as being  r e p r e s e n t a t i v e of v a r i o u s emotions (Depression and Happiness).  Write down as many a d j e c t i v e s or  d e s c r i p t i v e terms of these emotions as you can. them In any order.  write  Allow y o u r s e l f a couple of minutes  109 per emotion. Based on the 18 s u b j e c t s , the exemplars s e l e c t e d f o r use i n the present study had an o v e r a l l average production frequency The  of 6.2  (SD = 1.75) with a range of three to nine.  Happiness exemplars had an o v e r a l l average production  frequency  of 6.2  (SD = 2.28) with a range of three to nine.  S i m i l a r l y , the Depression exemplars had an o v e r a l l p r o d u c t i o n frequency to  of 6.2 (SD = 1.30) with a range of f i v e  eight.  Procedure Half of the s u b j e c t s w i t h i n each group were i n the primed c o n d i t i o n . list  For t h i s c o n d i t i o n , s u b j e c t s rated the  of stimulus words on how much they l i k e d each word.  Words were presented  v e r b a l l y , one a t a time.  The rate of  p r e s e n t a t i o n was i n d i v i d u a l l y t a i l o r e d , depending on how long s u b j e c t s took to rate each word. were presented categories.  first,  F i v e p r a c t i c e words  which were u n r e l a t e d to any of the  Subjects then completed the category  production  task u s i n g the f o l l o w i n g i n s t r u c t i o n s , which were modified from Graf et a l . (1985): Now we w i l l do something d i f f e r e n t . give you a t i t l e  I'm going t o  - the name of a category.  you t o say e i g h t things that belong  I want  to that category as  f a s t as you can. For example, I f the category i s " r e l a t i v e " , some things t h a t belong to that category might be aunt,  uncle, and s i s t e r .  Now  you give some  examples (Subjects provided examples).  Now, the next  110 category belong  label  to t h a t  is  __.  Give e i g h t exemplars that  category.  (The category t i t l e s Depression, and  Diseases  were presented.  Happiness,  Flowers,  To a v o i d sequence  e f f e c t s , s u b j e c t s r e c e i v e d one of the e i g h t p o s s i b l e orders of p r e s e n t a t i o n ) . Subjects*  responses were recorded.  Next, s u b j e c t s were  given the e x p l i c i t memory task with the i n s t r u c t i o n s : Fine.  Now I'm going to ask you to r e c a l l as many  words as you can from the l i s t rate.  t h a t you were asked to  Write those words on t h i s piece of paper.  R e c a l l as many as you can, and r e c a l l them i n any order t h a t you p l e a s e . The  remaining  Go ahead.  h a l f of the s u b j e c t s were i n the unprlmed  c o n d i t i o n , and were given only the category production  test.  These data provided a b a s e l i n e a g a i n s t which the p r e v i o u s l y primed p r o d u c t i o n data were compared. The  assignment of subjects i n the primed or unprlmed  c o n d i t i o n s was determined randomly, with the c o n s t r a i n t that equal p r o p o r t i o n s w i t h i n the t h r e e . s u b j e c t s groups appeared in each c o n d i t i o n . Hypotheses (a)  There would not be a d i f f e r e n t i a l r e c a l l rate f o r the  different (b)  c a t e g o r i e s f o r any of the three s u b j e c t groups.  In c o n t r a s t to the above, depressed  schematic  I n d i v i d u a l s would show a greater e f f e c t of priming depression-content  f o r the  words than nondepressed nonschematic  Ill individuals. nondepressed  A similar  p a t t e r n was e x p e c t e d  nonschematic s u b j e c t s  f o r the  f o r the happiness-related  words. (c)  Implicit  memorial processes  vulnerability depressed those  markers  a r e s e n s i t i v e measures o f  for depression.  individuals'  The r e m i t t e d  p a t t e r n of r e s u l t s  of the c u r r e n t l y depressed  would  resemble  individuals.  Results Analysis From t h e i m p l i c i t was t h e number task.  and as  category  type  (depression,  a within-subjects  was t h e number  (CDG, RDG, NDG) and  happiness,  flower,  disease)  factor. memory t a s k ,  o f words c o r r e c t l y  primed c o n d i t i o n s .  two-factor  on t h e g e n e r a t i o n  ( p r i m e d , unprlmed) as b e t w e e n - s u b j e c t s f a c t o r s ,  From t h e e x p l i c i t  the  measure  was a t h r e e - f a c t o r s mixed a n a l y s i s o f  c o n s i s t i n g of groups  conditions  the dependent  o f t a r g e t words p r o d u c e d  The d e s i g n  variance,  memory t a s k ,  mixed d e s i g n ,  the dependent  recalled  by s u b j e c t s i n  The a n a l y s i s o f v a r i a n c e which c o n s i s t e d  measure  involved a  o f g r o u p s (CDG,  RDG, NDG) as a b e t w e e n - s u b j e c t s  f a c t o r , and c a t e g o r y  (depression,  disease)  subjects  happiness,  flower,  type  as a w i t h i n -  factor.  Scoring In b o t h t h e word g e n e r a t i o n o c c a s i o n a l l y changed t h e s u f f i x changing  i t s meaning  (e.g.,  and r e c a l l  tasks,  of the stimulus  joyous c o u l d  subjects  word  without  have been used f o r  joyful).  Two  methods of s c o r i n g were t h e r e f o r e c a r r i e d  out:  one which scored these as e r r o r s , and a more l e n i e n t system which counted  these as c o r r e c t .  Analyses  methods were e s s e n t i a l l y the same.  from the  two  For t h i s reason and  to  be c o n s i s t e n t with other s i m i l a r s t u d i e s (e.g., Graf et a l . , 1985; Mathews, Mogg, May, from the s t r i c t  & Eysenck, 1989), only the  results  s c o r i n g system are r e p o r t e d .  I m p l i c i t Memory Task The means f o r the p r o d u c t i o n task are presented Table 9.  The  in  r e s u l t s of the ANOVA are summarized i n  Appendix L - Table As expected,  1. a s i g n i f i c a n t main e f f e c t was  found f o r  priming, F ( l , 5 4 ) = 18.41, p_ < .001, i n d i c a t i n g t h a t the words presented  l n the primed c o n d i t i o n lead to a g r e a t e r  p r o b a b i l i t y of being produced vs.  .86).  More i m p o r t a n t l y , however, there was  nonsignificant  i n t e r a c t i o n between group and  c o n d i t i o n , F(2,54) = 1.15, groups were roughly s i m i l a r priming e f f e c t .  The  (1.61  a  priming  p_ > .10, suggesting t h a t the in their a b i l i t i e s  to show the  priming c o n d i t i o n x category  i n t e r a c t i o n b a r e l y reached  s i g n i f i c a n c e , £ ( 3 , 1 6 2 ) = 2.69, p_  < .05, with Greenhouse-Geisser of  i n the p r o d u c t i o n task  central theoretical  correction.  i n t e r e s t , there was  a  s i g n i f i c a n t three-way i n t e r a c t i o n between group x category type x priming, F ( 6 , 162) = 2.24, hypotheses 2 and  3 suggest  p_ < .05.  within-group  P r e d i c t i o n s from  follow-up  comparisons across the d i f f e r e n t content c o n d i t i o n s .  113 Table 9 Number of Words Generated i n the I m p l i c i t  CDG UP  Task  RDG P  UP  NDG P  UP  P  Category C o n d i t i o n Depression M .73 SD ( .64) '  1.,33 ( ,71) .  .67 1.,64 ( .71) '(1.,21)  Happiness  M  .82 SD ( .60)  1.,67 (1., 32)  .67 (.70)  1..82 ( .87) .  Flower  M  1,.56 (1..33)  .67  1,.27  (.86) (1..42)  1,.78 (1 .09)  (.73) (1 .21)  Disease  .27  SD (.47) M  .73  SD (.79)  Notes. CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group. NDG = Nondepressed group. UP = unprlmed c o n d i t i o n . P = primed c o n d i t i o n .  .56  1..54  1.,67 (2.,83)  ,82 ( ,75) '.  1..54 1.,78 ( .97) , (1..04) . 56  2,.18  (1..25) ( .73) • 2,.18 1..22 ( .44)(1,.08)  114  However, an e x a m i n a t i o n analysis nature  of T a b l e 9 suggests t h a t  would c o n t r i b u t e  o f the  generated  interaction  that  i s , a l l three  To  limit  of d e p r e s s i o n and  from  t h e CDG,  comparison  happiness  group  CDG  g(3,162) =  f o r the h a p p i n e s s differences:  v s . RDG:  nonsignificant  t h e r e was  CDG  g(3,162) =  In a d d i t i o n ,  and  and  g(3,162) = 2.32,  g( 3,162) = 1.28,  .10,  .51,  p_ >  .05.  t h e NDG  on  suggest  p_ > -05.  significantly  A similar  g(3,162) = vs.  the  approach analysis  category, unexpectedly, v s . NDG:  that  NDG,  showed  .59,  .68,  p_ > ,05;  RDG  the o v e r a l l  analysis  of v a r i a n c e  p_ >  the  Unexpectedly, d i d not  1  categories.  than the  but d i d not d i f f e r e d  between t h e CDG  significance, conducted  p. < .05,  number  o f Type  were c o n d u c t e d  showed more o f a p r i m i n g e f f e c t  g ( 3 , 1 6 2 ) = 3.74,  than  conditions  the t o t a l  the p o s s i b i l i t y  between-groups c o m p a r i s o n conditions  within content  the d e p r e s s i o n c a t e g o r y , Tukey comparisons  t h e RDG  the  groups  h a p p i n e s s - r e l a t e d words  more p r o m i s i n g e f f e c t s .  critical  no  of  between g r o u p s  op a n a l y s e s , t h e r e b y l i m i t i n g  For  t o the c l a r i f i c a t i o n  words.  A comparison  errors,  an  effect,  more.previously rated  depression-related  produced  little  such  p_ >  .05;  NDG:  .05.  main e f f e c t s  f o r groups,  F ( 2 , 5 4 ) = 2.17,  c a t e g o r y t y p e , F ( 3 , 1 6 2 ) = 1.30, a nonsignificant  c a t e g o r y t y p e , F(6,162) =  interaction .29,  p_ >  .10.  produced  p_ > .10.  As  between g r o u p  p_ > well,  by  115  Explicit  Memory  The  Data.  means from t h i s  task  a r e presented  whereas t h e a n a l y s i s o f v a r i a n c e  i n Table  results are presented i n  Table  2 o f A p p e n d i x L.  there  was a n o n s i g n i f i c a n t g r o u p x c a t e g o r y  interaction, hypothesis  10,  Of c e n t r a l  theoretical  importance,  type  F ( 6 , 8 1 ) = .88, p_ > .10, which s u p p o r t s t h e  that the e x p l i c i t  memory t a s k  i s an  insensitive  m e m o r i a l measure o f s c h e m a t i c  processing.  nonsignificant  f o r g r o u p s , F ( 2 , 2 8 ) = .30, p. >  .10,  negating  overall  effect  the p o s s i b i l i t y  showed a n y memory d e f i c i t s . significant p_ < .001. interest,  main e f f e c t Since  this  follow-up  T h e r e was a  t h a t the depressed In a d d i t i o n , t h e r e  for category  effect  type,  group was a  F ( 3 , 8 1 ) = 28.52,  was n o t of t h e o r e t i c a l  comparisons  were not c o n d u c t e d .  Summary Consistent with explicit schematic  memory t a s k processing.  p r e d i c t i o n s from f i r s t was an i n s e n s i t i v e With r e s p e c t  hypotheses, the s e n s i t i v i t y somewhat s u p p o r t e d . subjects  showed a g r e a t e r  measure o f p o t e n t i a l  t o t h e s e c o n d and t h i r d  of the i m p l i c i t  As p r e d i c t e d , priming  h y p o t h e s i s , the  memory t a s k  remitted effect  depressed  than t h e  nondepressed  subjects  result  n o t have been due t o t h e r e m i t t e d  could  subjects' not  greater  f o r depression-content  propensity  show s u p e r i o r p r i m i n g  Unfortunately, results.  the r e s u l t s  First,  f o r priming,  f o r the other  was  stimuli.  This  depressed  because  they d i d  categories.  a r e weakened by two u n e x p e c t e d  the c u r r e n t l y depressed  subjects d i d not  Table  10  Number of words Recalled f o r the E x p l i c i t  Category  CDG  RDG  Task  NDG  Condition  Depress ion  M SD  .89 (li ,05)  ( .52) '.  1, .09 (1. ,22)  Happiness  M SD  1, , 22 (1. .09)  1, .09 ( ,.83)  1. ,00 (2. ,54)  Flower  M SD  2, .11 (1, .27)  2,.55 (1, .37)  2, ,55 (1. ,63)  Disease  M SD  2. .11 (1. .17)  2, .18 (1. .32)  ( .,67)  Note. CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group. NDG = Nondepressed group.  \  .45  .  2, ,64  117 show t h i s e f f e c t ,  second, no group d i f f e r e n c e s  observed f o r the p o s i t i v e  stimuli.  were  118  Chapter 10: T h i s chapter  S e l f - R e p o r t of  focuses  Cognitions  on s e l f - r e p o r t of c o g n i t i o n s .  c o n t r a s t to the automatic tasks used by t h i s t h e s i s , c o g n i t i o n s are r e a d i l y a c c e s s i b l e to conscious and  thus are hypothesized  Hopelessness Scale  (Hollon & K e n d a l l ,  awareness,  Automatic  1980),  (Beck et a l . , 1984), and  D y s f u n c t i o n a l A t t i t u d e Scale Beck,  these  not to be v u l n e r a b i l i t y markers.  Three s e l f - r e p o r t q u e s t i o n n a i r e s were used: Thoughts Questionnaire  In  the  (Welssman, 1980;  Welssman &  1978). Method  Measures Automatic Thoughts Q u e s t i o n n a i r e . Thought Q u e s t i o n n a i r e Appendix M)  (ATQ;  The  Hollon & K e n d a l l , 1980;  i s a s e l f - r e p o r t q u e s t i o n n a i r e which  the frequency  of d e p r e s s i o n - r e l a t e d c o g n i t i o n s .  are asked to r a t e on a 5-polnt s c a l e how experienced week.  range from 30 to 150, with higher  I n d i c a t i v e of higher  frequency  F a c t o r a n a l y s i s of the ATQ  of d e p r e s s i v e has  Subjects they  personal maladjustment and  expectations  (e.g., "My  cognitions. factor  d e s i r e for change self-concept  f u t u r e i s b l e a k " ) , low  w o r t h l e s s " ) , and  past  scores  produced a four  (e.g., "What's wrong with me?"), negative  (e.g., "I'm  often  see  assesses  30 d e p r e s s i o n - r e l a t e d c o g n i t i o n s i n the  Scores  solution:  Automatic  helplessness  and  self-esteem  (e.g., "I can't  f i n i s h anything") (Hollon & K e n d a l l , 1 9 8 0 ) .  These f a c t o r s  119  are i n concordance  with the d i s t o r t i o n s d e s c r i b e d by Beck e t  (1979).  al.  The  ATQ has demonstrated  strong Internal  Cronbach's alpha and the s p l i t - h a l f  reliability.  reliability  coefficient  were r e p o r t e d as . 8 7 or above, and . 9 6 , r e s p e c t i v e l y  (Dobson  & Shaw, 1 9 8 6 ; H a r r e l l & Ryon, 1 9 8 3 ; H o l l o n & K e n d a l l , 1 9 8 0 ) . T e s t - r e t e s t r e l i a b i l i t y estimates are not a v a i l a b l e to date. In  terms of v a l i d i t y ,  the ATQ has been found to  d i s c r i m i n a t e between depressed  and nondepressed  (Hollon & K e n d a l l , 1 9 8 0 ) .  T h i s expected  r e p l i c a t e d with a c l i n i c a l  sample  f i n d i n g has been  (Dobson & Shaw, 1 9 8 6 ) .  L i k e w i s e , a s t r o n g c o r r e l a t i o n has been found Beck Depression  students  between the  Inventory and the ATQ (r = . 6 2 to . 8 4 ;  Dobson & B r e i t e r , 1 9 8 3 ; Dobson & Shaw, 1 9 8 6 ) . Hopelessness et  al.,  designed  Scale.  The Hopelessness  1 9 7 4 ; see Appendix N) i s a 20-item t r u e / f a l s e  statements  from  pessimistic  made by p s y c h i a t r i c p a t i e n t s judged  as r e f l e c t i n g  by c l i n i c i a n s  f e e l i n g s of hopelessness.  Psychometric  data are a v a i l a b l e from Beck e t a l .  C o e f f i c i e n t alpha was r e p o r t e d as . 9 3 ,  strong i n t e r n a l c o n s i s t e n c y . from  scale  t o r e f l e c t negative expectancies about the f u t u r e .  Most of the s c a l e items were c u l l e d  (1974).  S c a l e (HS; Beck  $39 t o . 7 6 .  suggesting  Item-total correlations  Test-retest r e l i a b i l i t y  With r e s p e c t to concurrent v a l i d i t y ,  ranged  was not r e p o r t e d . Beck e t a l . ( 1 9 7 4 )  reported t h a t the HS c o r r e l a t e d h i g h l y with  clinicians'  r a t i n g s of hopelessness, with r e p o r t e d c o r r e l a t i o n of . 7 4  120 with a general p r a c t i c e  medical  sample, and .62 with a  sample of attempted s u i c i d e . p a t i e n t s .  In a d d i t i o n ,  correlated  ,62 with the pessimism item of the Beck  Depression  Inventory.  Dysfunctional Attitude Scale. A t t i t u d e Scale  The D y s f u n c t i o n a l  (DAS; Weissman, 1980; Weissman & Beck, 1978;  see Appendix 0) i s a 40-item s e l f - r e p o r t s c a l e . Beck's (1967) t h e o r e t i c a l contains a s e r i e s depressogenic indicate  the HS  Based on  formulation of d e p r e s s i o n , the DAS  of a t t i t u d e s  assumptions.  or b e l i e f s i n d i c a t i v e of  Respondents are asked to  the extent of t h e i r agreement with each statement  on a 7-point  s c a l e , y i e l d i n g a range of scores from 40 to  280. Psychometric  p r o p e r t i e s of the DAS are  satisfactory.  Cronbach's alpha c o e f f i c i e n t s range from .80 to .91, suggesting a high l e v e l of i n t e r n a l c o n s i s t e n c y B r e l t e r , 1983; Dobson & Shaw, 1986; O l i v e r 1985).  Moderate to good t e s t - r e t e s t  (Dobson &  & Baumgart,  reliability  c o e f f i c i e n t s are reported at .62 to .84 f o r 6 to 12 week intervals  (Hamilton  & Abramson, 1983; O'Hara, Rehm, and  Campbell, 1982; O l i v e r  & Baumgart, 1985; R i s k l n d , Beck, &  Smucker, 1983; Weissman, 1978). related  The DAS i s moderately  to measures of depression.  Reported  c o e f f i c i e n t s between the DAS and the Beck  correlation  Depression  i n v e n t o r y range from .30 to .64 (Dobson & B r e i t e r , 1983; Dobson & Shaw, 1986: O l i v e r the r e l a t i o n s h i p  & Baumgart, 1985).  Note that  i s only a moderate one, suggesting  that the  121 DAS  Is somewhat r e l a t e d , but c o n c e p t u a l l y d i f f e r e n t ,  measures of d e p r e s s i o n .  from  Stronger r e l a t i o n s h i p s have been  found with more c o n c e p t u a l l y s i m i l a r measures, such as the Thoughts Q u e s t i o n n a i r e (r = .78;  Automatic 1986)  and the Measures of D i s t o r t e d and  (r = .62;  Dobson & Shaw,  Depressed c o g n i t i o n s  Krantz & Hammen, 1979).  Procedure Subjects were asked  to f i l l  out the  q u e s t i o n n a i r e s , with the experimenter  self-report  a v a i l a b l e to answer  any p r o c e d u r a l q u e s t i o n s . Hypotheses (a)  As c o n s i s t e n t l y demonstrated  c u r r e n t l y depressed  in previous  i n d i v i d u a l s were expected  literature, to r e p o r t more  d e p r e s s i o n - r e l a t e d c o g n i t i o n s than nondepressed (b)  individuals.  C o g n i t i o n s t h a t r e q u i r e e l a b o r a t i v e p r o c e s s i n g are, i n  g e n e r a l , hypothesized not to be s e n s i t i v e measures of v u l n e r a b i l i t y markers i n d e p r e s s i o n . s u b j e c t s * responses  Remitted  depressed  on these s e l f - r e p o r t measures would be  s i m i l a r to that of nondepressed  individuals.  Results Analysis The dependent measures were scores obtained from the ATQ,  HS,  (CDG, P.  and DAS.  RDG,  NDG)  Each was  submitted t o a between-groups  a n a l y s i s of v a r i a n c e , summarized  The means are presented i n Table  11.  i n Appendix  Table 11 Questionnaire  Scores  CDG Self-report DAS  ATQ  HS  RDG  NDG  questionnaires M ADM SD  168.00  120.25  102.75  (51.93)  (41.10)  (24.48)  M ADM SD  110.55  49.90 46.59 (20.24)  35.35 38.66 (7.11)  M ADM SD  13.53  5.55 4.59 (1.37)  2.50 3.46 (1.23)  N. A.  N. A. (26.77)  N. A. (1.27)  N. A.  N. A.  Note . CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group. NDG = Nondepressed group. ADM = Adjusted means r e s u l t i n g from the a n a l y s i s of covariance. DAS = D y s f u n c t i o n a l A t t i t u d e S c a l e . ATQ = Automatic Thoughts Questionnaire HS = Hopelessness S c a l e .  123 DAS For  the DAS  main e f f e c t  data, there was,  f o r groups  as expected, an  overall  ( F ( 2 , 5 7 ) = 1 3 . 9 0 , p. < . 0 0 1 ) .  Tukey  comparisons suggested t h a t the CDG  scoring s i g n i f i c a n t l y  higher than the other two groups:  CDG v s . NDG:  7.20, p_ < . 0 1 ; CDG vs. RDG: as expected, the RDG  was  g(3,57) =  g ( 3 , 5 7 ) = 5 . 2 9 , p_ < . 0 1 . Also  not d i s t i n g u i s h a b l e from the  NDG,  g ( 3 , 57) = 1 . 9 3 , p_ > . 0 5 .  hm For effect,  the ATQ d a t a , there was an o v e r a l l  F ( 2 , 5 7 ) = 8 2 . 8 1 , p_ < .001, as expected.  comparisons showed that the CDG scores than both the NDG, RDG,  s i g n i f i c a n t main Tukey  had s i g n i f i c a n t l y higher  g ( 3 , 5 7 ) = 1 1 . 6 6 , p_ < . 0 1 , and the  g ( 3 , 5 7 ) = 8 . 4 3 , p_ < . 0 1 . Furthermore, the RDG  s l i g h t l y higher than the NDG,  scored  g ( 3 , 5 7 ) = 3 . 2 3 , p_ < . 1 0 .  HS The HS data p a r a l l e l e d significant overall  effect,  the ATQ data.  F ( 2 , 5 7 ) = 3 6 . 2 2 , p_ < . 0 0 1 .  Tukey comparisons showed the CDG than the two other groups .01; the  CDG RDG  vs. NDG:  There was a  scored s i g n i f i c a n t l y higher  (CDG vs. RDG:  g ( 3 , 57) = 1 1 . 6 6 , p_ <  g ( 3, 57 ) = 8 . 4 3 , p_ < . 0 1 ) .  Furthermore,  had s l i g h t l y higher scores than the NDG,  g(3,57) =  3.23, p_ < .10 Contrary to p r e d i c t i o n s , the remitted depressed s u b j e c t s were d i s t i n g u i s h a b l e from the nondepressed  subjects  ln  terms of t h e i r responses on the ATQ and the HS a t p_ l e v e l  of  .10.  Could t h i s d i f f e r e n c e be due to e x i s t i n g  group  124  d i f f e r e n c e s i n age and BDI s c o r e s ?  As a p r e l i m i n a r y t e s t ,  c o r r e l a t i o n a l analyses were conducted f o r the r e m i t t e d and nondepressed s u b j e c t s o n l y .  The analyses showed no  c o r r e l a t i o n s with age (age with HS: r = .03; age with ATQ: r = .08), but s u b s t a n t i a l c o r r e l a t i o n s with BDI scores (BDI with HS: r = .66; BDI with ATQ:  r = .74).  Given the l a t t e r  r e s u l t , an attempt was made to a d j u s t f o r t h i s d i f f e r e n c e between groups by an a n a l y s i s of c o v a r i a n c e using BDI scores as the c o v a r i a t e .  The adjusted means from the a n a l y s i s of  c o v a r i a n c e are presented c o v a r i a n c e , presented  i n Table  i n Tables  11.  The r e s u l t s of the  4 and 5 of Appendix P, show  t h a t group d i f f e r e n c e s i n both ATQ and HS scores disappeared:  r e s p e c t i v e l y , £ ( 1 , 3 6 ) = 1.50, p_ > .10, F ( l , 3 7 )  = 1.46, p_ > .10.  Summary C o n s i s t e n t with the f i r s t depressed  hypothesis, c u r r e n t l y  s u b j e c t s endorsed more d e p r e s s i o n - r e l a t e d  c o g n i t i o n s than r e m i t t e d depressed  or nondepressed s u b j e c t s .  When c o v a r y i n g out the e f f e c t s of BDI s c o r e s , r e m i t t e d depressed  s u b j e c t s endorsed no more d e p r e s s i o n - r e l a t e d  c o g n i t i o n s than nondepressed s u b j e c t s , lending support t o the second hypothesis  t h a t the c o g n i t i o n s , as assessed by  t h i s b a t t e r y of q u e s t i o n n a i r e s , are not s e n s i t i v e measures of v u l n e r a b i l i t y markers t o d e p r e s s i o n .  Chapter One greater The  11:  Follow-up  Data  m a n i f e s t a t i o n of d e p r e s s i v e v u l n e r a b i l i t y i s a l i k e l i h o o d to develop  i s s u e of the e l i g i b i l i t y  v u l n e r a b i l i t y markers was  f u t u r e depressive  episodes.  of the Time 1 measures of  re-examined by a s c e r t a i n i n g  whether these measures were p r e d i c t i v e of future d e p r e s s i o n status.  I t i s noted  t h a t the p r e d i c t i o n aspect of the  t h e s i s i s considered to be e x p l o r a t o r y .  That  i s , solutions  from r e g r e s s i o n analyses based on such a small sample s i z e may  not c r o s s - v a l i d a t e ( H a r r i s , The  1975).  i n t e n t of t h i s aspect of the study was  to measure  the r a t e of recurrence of d e p r e s s i v e symptoms, as by the Beck Depression  Inventory,  experimental  Three months was  session.  assessed  3 months a f t e r the  initial  chosen because  r e s e a r c h has shown a good p r o b a b i l i t y of 20-24% of r e l a p s e w i t h i n 3 months of r e c o v e r y  (Belsher & C o s t e l l o , 1988). Method  Materials Beck Depression write-up  Inventory.  Refer to the m a t e r i a l s  In Subjects s e c t i o n .  Procedure For the c u r r e n t l y depressed s e s s i o n was  conducted  Since the i n t e n t was  s u b j e c t s , the  during t h e i r depressive to measure recurrence and  maintenance of d e p r e s s i v e symptoms, I t was for  experimental episodes. not  necessary to wait  the a l l e v i a t i o n of these s u b j e c t s ' symptoms.  c u r r e n t l y depressed  Thus,  s u b j e c t s were followed to the p o i n t of  126. r e m i s s i o n , d e f i n e d as t h e i r d i s c h a r g e The o r i g i n a l  from the h o s p i t a l .  i n t e n t was to o b t a i n an o b j e c t i v e measure of  the a l l e v i a t i o n of symptoms, such as scores from the BDI or the HRSD. these  However, t h i s proved t o be impossible,  p a t i e n t s were often discharged  notice.  For these  with very  little  s u b j e c t s , the BDIs were mailed  months a f t e r t h e i r d i s c h a r g e .  because  out 3  The p s y c h i a t r i s t as w e l l as  the p s y c h i a t r i c nurses were a l e r t e d of the c r i t e r i a of r e m i s s i o n , and Informed the experimenter of the p a t i e n t ' s status.  The time l a g between the experimental  s e s s i o n and  the m a i l i n g of the BDIs was noted f o r each c u r r e n t l y depressed s u b j e c t , and was matched f o r both a remitted depressed and a nondepressed  subject.  Hypothes i s (a)  Measures of depressive  automatic p r o c e s s i n g are  p r e d i c t i v e of f u t u r e depressive power of these  symptoms.  The p r e d i c t i v e  measures goes beyond t h a t of the s e l f - r e p o r t  q u e s t i o n n a i r e s and the i n i t i a l  l e v e l s of d e p r e s s i o n .  Results Analys i s To determine which c o g n i t i v e measures taken a t Time 1 were p r e d i c t i v e of r e l a p s e , as d e f i n e d by BDI scores  greater  than 14, a h i e r a r c h i c a l r e g r e s s i o n a n a l y s i s was conducted, using Time 2 BDI scores as the outcome v a r i a b l e .  The  p r e d i c t o r v a r i a b l e s used i n the r e g r e s s i o n a n a l y s i s were: scores from the ATQ, HS, and DAS, composite (described  i n the data t r a n s f o r m a t i o n  scores  s e c t i o n ) from the  127  d i c h o t l c l i s t e n i n g , probe d e t e c t i o n , and i m p l i c i t memory t a s k s , Time 1 BDI s c o r e s , and frequency depressive  episode.  of previous  The l a s t v a r i a b l e was Included  because  s e v e r a l s t u d i e s have found that v a r i a b l e t o be p r e d i c t i v e of relapse  (e.g., Dent & Teasdale,  s u b j e c t s who mailed  1988 ).  the q u e s t i o n n a i r e s  Broken down by groups, the average time lag3 between the experimental  s e s s i o n and the m a i l i n g of the follow-up  A  q u e s t i o n n a i r e s were: M = 6.40  CDG:  (SD = 2.67), NDG:  follow-up  data,  M =8.29 months (SD = 2.61), RDG: M = 9.01 (SD = 3.15).  summarized l n Table  of the 60 s u b j e c t s .  Time 2  12, were c o l l e c t e d on 54  A l l s u b j e c t s i n both the remitted  depressed and nondepressed groups completed the follow-up q u e s t i o n n a i r e s , while subjects f a i l e d telephoned BDI,  6 out of the 20 c u r r e n t l y depressed  t o r e t u r n t h e i r q u e s t i o n n a i r e s , even with a  reminder.  Using the c u t - o f f score of 15 on the  0 of the 20 s u b j e c t s i n the NDG, 9 of the 20 remitted  depressed s u b j e c t s , and 10 of the 14 CDG s u b j e c t s were classified Data  as depressed at follow-up.  Transformation Due  t o the m u l t i p l e measures used i n Time 1, an attempt  was made t o reduce the number of v a r i a b l e s by computing composite measures based on the c r i t i c a l c o n d i t i o n s . the d i c h o t l c l i s t e n i n g  For  task, a composite score was computed  for each s u b j e c t by s u b t r a c t i n g the d e t e c t i o n l a t e n c i e s a s s o c i a t e d with the p o s i t i v e words from those with the d e p r e s s i o n  words.  associated  For the v i s u a l probe task, the  128 Table  12  F o l l o v - u p Beck Depression Inventory scores  II  Depressed"!  II  Nondepressed"2  CDG (n=14)  M SD  29 . 25 (13.52)  4.33 (7.51)  RDG (n=20)  M SD  22. 33 (5.39)  6.18 (5.64)  NDG (n=20)  M SD  N.A.  1.63 (3.10)  Note. 1. Using the c r i t e r i o n of Beck Depression Inventory score >= 15. 2. Using the c r i t e r i o n of Beck Depression Inventory score < 15. CDG = C u r r e n t l y depressed group. RDG = Remitted depressed group. NDG = Nondepressed group.  129 critical  trials  presented  were those where the stimulus words were  l n the lower  h a l f of the screen followed by a  probe p r e s e n t a t i o n l n the lower those t r i a l s , trials  h a l f of the screen.  On  a composite score was made by s u b t r a c t i n g the  c o n t a i n i n g the p o s i t i v e words from those c o n t a i n i n g  the d e p r e s s i o n words.  Finally,  f o r the i m p l i c i t memory  task, a measure was computed from the d i f f e r e n c e of the p r o d u c t i o n of the p r e v i o u s l y primed happiness  words from  that of the d e p r e s s i o n words. Missing  data  From a sample of 60, 50 data p o i n t s were used i n the regression analysis. return t h e i r  S i x s u b j e c t s from the CDG f a i l e d to  follow-up q u e s t i o n n a i r e s .  Four s u b j e c t s from  the CDG and RDG were assigned missing values In the frequency response  of p r e v i o u s depressive episode v a r i a b l e .  In  t o the i n q u i r y of previous episodes, these s u b j e c t s  gave the response  " a l l my l i f e " .  Even when pressed to be  more s p e c i f i c , these s u b j e c t s were unable  t o give an  e s t i m a t e 0£ t h e number Of previous e p i s o d e s .  Consequently,  these s u b j e c t s were given missing values on t h a t v a r i a b l e . Regression A n a l y s i s R e s u l t s The  c o r r e l a t i o n s between p r e d i c t o r and outcome  v a r i a b l e s a r e presented i n Table 13, whereas c o r r e l a t i o n t a b l e s f o r the measures used l n t h i s t h e s i s are presented i n Appendix Q. The  hypothesis s t a t e s that measures of automatic  p r o c e s s i n g would be p r e d i c t i v e beyond s e l f - r e p o r t measures,  130  Table 13 C o r r e l a t i o n s between P r e d i c t o r V a r i a b l e s with Beck Depression Inventory scores  BDI-Tlme 1 BDI-Tlme 1 ATQ HS DAS D i c h o t l c l i s t e n i n g task V i s u a l probe task I m p l i c i t memory task Frequency of p r e v i o u s episodes of d e p r e s s i o n  BDI-Tlme 2  1.00 .91 .74 .46 .14 .37 .01  .77 .76 .62 .36 .14 .14 .03  .42  .67  Note. BDI-Tlme 1 = Beck Depression Inventory score at Time 1. BDI-Tlme 2 = Beck Depression i n v e n t o r y score at Time 2. ATQ = Automatic Thoughts Q u e s t i o n n a i r e . HS = Hopelessness S c a l e . DAS = D y s f u n c t i o n a l A t t i t u d e S c a l e .  131  Initial  BDI s c o r e s ,  and previous episodes of d e p r e s s i o n .  To  t e s t t h i s , the s e l f - r e p o r t measures, Time 1 BDI s c o r e s , and number of previous episodes were entered a t Step 1 of the regression  analysis.  The measures of automatic  processing  were entered a t Step 2. Step 1 v a r i a b l e s s i g n i f i c a n t l y p r e d i c t e d scores  ( M u l t i p l e R = .86, Adjusted R-squared=  Time 2 BDI .74, F(5,44) =  24.51, p_ < . 0 5 ) . The i n c l u s i o n of the measures of automatic measures d i d not add t o the p r e d i c t i o n a n a l y s i s  (Multiple R  = .86, Adjusted R-squared = . 7 4 ) . An a d d i t i o n a l r e g r e s s i o n  a n a l y s i s was conducted to  r e p l i c a t e p r e v i o u s f i n d i n g s that  initial  BDI scores and  h i s t o r y of d e p r e s s i o n are p r e d i c t i v e of f u t u r e levels. the  A regression  dysphoria  a n a l y s i s was conducted t h a t  allowed  c o n t r o l of the order of e n t r y of the v a r i a b l e s .  Time 1 BDI scores as the f i r s t regression  v a r i a b l e entered  a n a l y s i s produced a m u l t i p l e  Using  i n t o the  R of .76, Adjusted  R-squared = .56, F ( l , 4 8 ) = 37.30, p. < .001. The a d d i t i o n of the  frequency of previous episodes f u r t h e r c o n t r i b u t e d to  the  regression  analysis:  squared = .72, F ( 2 , 47)  M u l t i p l e R = .88, adjusted  R-  = 16.92, p_ < .01. Summary  Contrary t o p r e d i c t i o n s , responses on the tasks assessing  automatic measures were not p r e d i c t i v e of f u t u r e  d e p r e s s i o n s t a t u s . Indeed, these measures c o r r e l a t e d with Time 2 BDI s c o r e s : p r e d i c t future  r = .03 to .14.  poorly  I t was p o s s i b l e to  l e v e l s of d y s p h o r i a , with much of the  v a r i a n c e accounted for (adjusted R-squared = .68 and  .12),  with  of  i n i t i a l d e p r e s s i o n l e v e l s along with the h i s t o r y  p r e v i o u s episodes  of d e p r e s s i o n .  133 Chapter 12:  Discussion  Summary of F i n d i n g s The  aim of t h i s t h e s i s was t o f i n d support f o r  c o g n i t i v e v u l n e r a b i l i t y f a c t o r s In automatic p r o c e s s i n g of depression-related  Information.  Four main hypotheses were  examined: (a) C u r r e n t l y depressed I n d i v i d u a l s would show a b i a s f o r the d e p r e s s i o n - r e l a t e d s t i m u l i on the automatic tasks;  (b)  remitted depressed  i n d i v i d u a l s ' p a t t e r n of  performance on the automatic tasks would resemble t h a t of the c u r r e n t l y depressed i n d i v i d u a l s ;  (c) r e m i t t e d  depressed  i n d i v i d u a l s ' p a t t e r n of performance on the e f f o r t f u l  tasks  would resemble that of the nondepressed i n d i v i d u a l s ; and (d) data  from the automatic tasks would be p r e d i c t i v e of f u t u r e  depressive The the  symptoms.  first  hypothesis  i m p l i c i t memory task.  was only p a r t i a l l y supported i n S p e c i f i c a l l y , the r e m i t t e d  depressed s u b j e c t s , compared t o the nondepressed s u b j e c t s , showed a greater priming e f f e c t f o r the depression-content stimuli. obtained the  first  Unfortunately,  t h i s depressive  bias was not  f o r the c u r r e n t l y depressed s u b j e c t s , hypothesis,  a depressive  c o n t r a r y to  bias was not observed i n  the d i c h o t l c l i s t e n i n g and the probe d e t e c t i o n t a s k s . Rather, both groups of depressed subjects showed an evenhandedness i n t h e i r p r o c e s s i n g across the d i f f e r e n t conditions.  However, the nondepressed s u b j e c t s showed a  b i a s f o r the p o s i t i v e s t i m u l i . task, these  content  In the d i c h o t l c l i s t e n i n g  subjects had s h o r t e r d e t e c t i o n l a t e n c i e s when  the p o s i t i v e s t i m u l i , compared t o the d e p r e s s i o n - r e l a t e d s t i m u l i , were presented i n the unattended  channel.  Finally,  the probe d e t e c t i o n task was an i n s e n s i t i v e measure of depressed-nondepressed The  differences.  second hypothesis was examined only f o r the two  tasks t h a t were s e n s i t i v e t o differences.  depressed-nondepressed  This hypothesis was o n l y , p a r t l a l l y supported.  In the d i c h o t i c l i s t e n i n g task, the r e m i t t e d depressed s u b j e c t s ' p a t t e r n of performance c u r r e n t l y depressed  individuals.  was s i m i l a r to that of the Although the r e s u l t s  from  the i m p l i c i t memory task suggested that the remitted depressed s u b j e c t s showed more priming f o r the d e p r e s s i o n content words than the nondepressed  subjects, this  d e p r e s s i v e bias was not found f o r the c u r r e n t l y depressed r  subjects. The  t h i r d hypothesis was supported.  When the e f f e c t s  of Beck Depression Inventory scores were c o v a r i e d out, r e m i t t e d depressed: s u b j e c t s endorsed  no more d e p r e s s i o n -  r e l a t e d c o g n i t i o n s than the nondepressed  subjects.  the f o u r t h hypothesis was not supported.  Finally,  The automatic  measures were found not t o be p r e d i c t i v e of relapse of depressive  symptoms.  The apparent d i s c r e p a n c y between the second and f o u r t h hypotheses  can be r e s o l v e d with the view that depressive  automatic processes are " s c a r s "  (Lewinsohn  et a l . ,  from having experienced a d e p r e s s i v e episode. are  not v u l n e r a b i l i t y  factors  i n that  1981)  However, they  they do n o t s e r v e as a  135 p r e d i s p o s i t i o n to future d e p r e s s i o n . of t h i s study to p r e d i c t depressive  However, the  symptoms does not  n e c e s s a r i l y r u l e out the p o s s i b i l i t y that  depressive  automatic processes are v u l n e r a b i l i t y f a c t o r s . (1988) argued that the onset of d e p r e s s i v e of primary importance.  More c e n t r a l to the  of these depressive  I n t e r e s t to have continued  Teasdale  symptoms i s not issue of  v u l n e r a b i l i t y i s the study of the p e r s i s t e n c e exacerbation  Inability  symptoms.  and  I t would be  to f o l l o w these s u b j e c t s  of  to  determine whether the automatic measures are p r e d i c t i v e of the c h r o n l c i t y and  s e v e r i t y of the depressive  symptoms.  P o t e n t i a l L i m i t a t i o n s of Work Before d i s c u s s i n g the  i m p l i c a t i o n s of t h i s work, some  of i t s l i m i t a t i o n s are addressed. s t a t i s t i c a l considerations.  One  The  may  f i r s t area  addresses  argue that the  failure  of the p r e d i c t e d Fs to reach s i g n i f i c a n c e i n the probe d e t e c t i o n was  due  to the lack of power s i n c e a  small sample s i z e (n = 20)  was  used.  relatively  However, t h i s i s not  l i k e l y to be the case since the same sample s i z e was f o r the d i c h o t l c l i s t e n i n g task, but was task  for that  to show s i g n i f i c a n t r e s u l t s . One  may  argue that d i f f e r e n c e s i n the r e s u l t s between  the tasks a s s e s s i n g lie  sufficient  used  automatic and  l n the s t a t i s t i c a l analyses  the a n a l y s i s of covariance Scale and  was  e f f o r t f u l processes  conducted.  In p a r t i c u l a r ,  a p p l i e d to the  Hopelessness  the Automatic Thoughts Questionnaire,  a p p l i e d to any  of the tasks a s s e s s i n g  may  automatic  but was  not  processes.  136  As Kirk  (1982) noted, one c o n d i t i o n f o r an a n a l y s i s of  covariance i s an adequate  magnitude of c o r r e l a t i o n between  the c o v a r i a t e and the dependent v a r i a b l e s . was warranted Automatic  Such an a n a l y s i s  i n the cases of the Hopelessness  Thoughts Q u e s t i o n n a i r e , because  between t h e s e and the Beck D e p r e s s i o n  Scale and the  correlations  i n v e n t o r y scores were  s u f f i c i e n t l y high (.91 and .74, r e s p e c t i v e l y ) , but was not warranted  f o r the automatic measures because  these measures  were v e r y much l e s s c o r r e l a t e d with Beck Depression Inventory s c o r e s (r = .01 to . 3 7 ) . The p o s s i b i l i t y e x i s t s that the p a t t e r n of r e s u l t s obtained may be r e f l e c t i n g the c h a r a c t e r i s t i c s of the s u b j e c t s groups.  The c e n t r a l hypothesis i n t h i s t h e s i s i s  that the two depressed groups d i f f e r group on t h e i r p r o c e s s i n g s t y l e . accounted  from the nondepressed  That d i f f e r e n c e may be  f o r by the d i f f e r e n c e i n the medication status of  the groups.  That  i s , a l l s u b j e c t s i n the c u r r e n t l y  depressed group and 8 of the 20 r e m i t t e d depressed subjects were on a n t i d e p r e s s a n t s . nondepressed  Presumably,  none of the  s u b j e c t s were on a n t i d e p r e s s a n t s .  e f f e c t s of a n t i d e p r e s s a n t s may be a confounding Another  Thus, the factor.  l i m i t a t i o n of t h i s study i s i t s f a i l u r e to  s p e c i f i c a l l y address whether automatic p r o c e s s i n g bias i s s p e c i f i c to depressive disorders.  The absence  of a general  p s y c h i a t r i c c o n t r o l group means that one cannot r u l e out that the obtained e f f e c t s are due to g e n e r a l psychopathology,  r a t h e r than t o d e p r e s s i o n per se.  137  This r e s e a r c h assessed  automatic  and  effortful  p r o c e s s i n g by a l i m i t e d number of t a s k s . r e s u l t s are l i m i t e d to a t t e n t i v e , self-report biases. automatic  As such,  these  i m p l i c i t memorial, and  C e r t a i n l y , f u t u r e r e s e a r c h addressing  processes as measures of v u l n e r a b i l i t y markers  needs to use other tasks which assess automatic  processes.  P o t e n t i a l C o n t r i b u t i o n s of the Study Despite these l i m i t a t i o n s , t h i s r e s e a r c h contains p o t e n t i a l c o n t r i b u t i o n s to the c o g n i t i v e v u l n e r a b i l i t y field.  T h i s r e s e a r c h may  o f f e r a refinement  theory l n at l e a s t two ways. examining  schematic  the e x i s t i n g  support.  This literature  f o r the most p a r t , tasks r e q u i r i n g  processes.  literature  processes as v u l n e r a b i l i t y markers, on  the whole, has y i e l d e d l i t t l e used,  First,  to schema  has  effortful  However, the r e s u l t s from t h i s r e s e a r c h suggest  that the d i s t i n c t i o n between automatic  and  effortful  processes  i n u n i p o l a r depression i s v a l i d , and that  automatic  but not e f f o r t f u l processes may  markers.  I f schemata are seen as v u l n e r a b i l i t y markers,  be  vulnerability  then perhaps schemata should be r e c o n c e p t u a l i z e d as i n v o l v i n g only automatic  processes.  Second, schema theory and past r e s e a r c h suggest t h a t depressed  v u l n e r a b l e I n d i v i d u a l s are c h a r a c t e r i z e d by a  depressive bias.  In the a t t e n t i o n a l t a s k s of the d i c h o t l c  l i s t e n i n g task, a depressive b i a s was depressed  groups.  not found  for the  Rather, what d i s t i n g u i s h e d the  groups from the nondepressed group was  two  depressed  the l a c k of p o s i t i v e  138 bias.  I t i s noted that previous research which found a  d e p r e s s i v e b i a s used tasks which tapped processes.  Together,  into  effortful  these r e s u l t s suggest an o r d e r i n g of  type of b i a s e s a c c o r d i n g to c o g n i t i v e processes. particular,  i t i s suggested  In  that d e p r e s s i v e a t t e n t i v e  processes are c h a r a c t e r i z e d by a lack of p o s i t i v e b i a s while effortful  processes  (memorial  processes, r e p o r t i n g of  c o g n i t i o n s ) are c h a r a c t e r i z e d by a d e p r e s s i v e b i a s . adopt  the assumption  t h a t automatic  processes  (Kahneman, 1973).  processes  For example,  needs to attend to an Item before one can r e c a l l appears  now  i n v o l v e the  e a r l y stages or p r o c e s s i n g , whereas the e f f o r t f u l i n v o l v e the l a t e r stages  I  one  i t . So i t  t h a t at the e a r l y stages of p r o c e s s i n g , a depressed  i n d i v i d u a l processes s t i m u l i without a p o s i t i v e b i a s .  But  at the l a t e r stages of e f f o r t f u l p r o c e s s i n g , where the depressed  individual  i s allowed to e l a b o r a t e and i n t e g r a t e  the i n f o r m a t i o n , a d e p r e s s i v e bias develops.  This p a t t e r n  r a i s e s the p o s s i b i l i t y t h a t a p o s i t i v e b i a s i n the e a r l y stages of p r o c e s s i n g somehow serves to prevent c o n s t r u i n g of Information  the  i n a depressogenic manner.  In terms of methodological  issues, t h i s research p o i n t s  to the need of u s i n g more than one method of a s s e s s i n g vulnerability.  T h i s r e s e a r c h shoved that sometimes measures  of v u l n e r a b i l i t y do not correspond,  specifically,  of c o g n i t i v e v u l n e r a b i l i t y was  in depressive-style  found  p r o c e s s i n g i n r e m i t t e d depressed not be p r e d i c t i v e of r e l a p s e .  evidence  i n d i v i d u a l s , but t h i s  This l a c k of  may  correspondence  139  may  suggest  t h a t the nature of c o g n i t i v e v u l n e r a b i l i t y i s  complex and m u l t i f a c e t e d . i n d i v i d u a l s may  That  i s , markers of v u l n e r a b l e  not be p r e d i c t i v e of r e l a p s e , and what i s  p r e d i c t i v e of r e l a p s e may  not be p r e d i c t i v e of the onset of  a d e p r e s s i v e episode, and so f o r t h .  To tease out some of  these p o t e n t i a l r e l a t i o n s h i p s , r e s e a r c h examining c o g n i t i v e v u l n e r a b i l i t y needs to include more t h a t one method of measuring  vulnerability.  This r e s e a r c h might p o t e n t i a l l y have c l i n i c a l Implications. been based  T r a d i t i o n a l l y , the outcome of therapy  s o l e l y on p a t i e n t s ' s u b j e c t i v e r e p o r t s of  wellness and  the absence of symptoms.  t h e s i s suggest ongoing  has  The  r e s u l t s of t h i s  t h a t d e s p i t e t h e i r s u b j e c t i v e sense,  an  v u l n e r a b i l i t y - not n e c e s s a r i l y subject to conscious  awareness - may  still  persist.  I f l e f t unchecked, these  i n d i v i d u a l s may  be very l i k e l y  to r e l a p s e at some future  time.  I t may  automatic  be p o s s i b l e that some experimental c o g n i t i v e  tasks may  be used to i d e n t i f y  i n d i v i d u a l s who  w e l l but, n e v e r t h e l e s s , r e q u i r e f u r t h e r treatment et  seem  (Williams  a l . , 1988) . 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As b e f o r e , these questions are a standard s e t of questions that I ask everybody. The questions w i l l cover some of the kinds of problems or d i f f i c u l t i e s that many people have a t some time d u r i n g t h e i r l i v e s . Some of the questions may not be a p p l i c a b l e , but i t i s important t o ask them of everybody.  1.  Were you ever a p a t i e n t ward?  In a p s y c h i a t r i c h o s p i t a l or  If yes, Whom d i d you see? What kinds of problems were you having 2.  then?  Have you ever seen anyone f o r emotional problems, your nerves, or the way you were f e e l i n g or a c t i n g ? If yes, Whom d i d you see? What k i n d s  3.  o£ p r o b l e m s were y o u h a v i n g  then?  were there any times when you or someone e l s e f e l t that you needed help because of your f e e l i n g s , your nerves, or the way you were a c t i n g ? If yes, What kinds of problems were you having then?  i  160  Assessment of h i s t o r y o£ d e p r e s s i o n Now, t h i n k of the worst week of your l i f e , in your l i f e .  the lowest p o i n t  Have you got a week i n mind? During t h i s most severe p e r i o d , 1.  Were you bothered by f e e l i n g depressed, sad, blue, hopeless, or down l n the dumps? Did those f e e l i n g s l a s t more than one week? How about more than two weeks? During that p e r i o d , were you bothered by f e e l i n g s that you d i d n ' t care anymore, or d i d n ' t enjoy anything? Did those f e e l i n g s l a s t more than one week? How about more than two weeks? What about  2.  feeling  irritable  or e a s i l y annoyed?  During t h a t time d i d you seek help from anyone l i k e a d o c t o r , or m i n i s t e r or even a f r i e n d , or d i d anyone suggest that you seek help? Did  you take any medication?  Did you a c t d i f f e r e n t l y with people, your f a m i l y , a t work, or a t school? 3.  During the most severe p e r i o d were you bothered by .... poor a p p e t i t e or weight weight gain?  l o s s , or Increased a p p e t i t e or  t r o u b l e s l e e p i n g or s l e e p i n g too much? l o s s of energy, e a s i l y f a t i g u e d , or f e e l i n g  tired?  l o s s of i n t e r e s t or p l e a s u r e i n your usual a c t i v i t i e s or i n sex? f e e l i n g g u i l t y or down on y o u r s e l f ? t r o u b l e c o n c e n t r a t i n g , t h i n k i n g , or making d e c i s i o n ? t h i n k i n g about death or s u i c i d e ? suicide?) being unable to s i t s t i l l  (Did you attempt  and have t o keep moving or  the opposite - feeling slowed down and have trouble moving? Did anything cause the depression? (Do not i n c l u d e i f due t o uncomplicated bereavement. G u i d e l i n e s f o r d e f i n i n g "uncomplicated bereavement": - the d e p r e s s i v e syndrome d i d not l a s t more than s i x months - there was no s u i c i d e attempt nor great s u i c i d a l preoccupation or t a l k (some I d e a t i o n i s common) - no h o s p i t a l i z a t i o n - no marked r e t a r d a t i o n - no morbid preoccupation with g u i l t or s e l f - w o r t h How long d i d the d e p r e s s i o n How many episode  last?  l i k e t h i s have you had?  I f unable t o give exact number: Would you say t h a t you have had a t l e a s t d i f f e r e n t episodes l i k e t h a t ?  162 Assessment 1.  f o r e p i s o d e s of  mania.  D i d you e v e r have a p e r i o d when you f e l t e x t r e m e l y good or h i g h - c l e a r l y d i f f e r e n t f r o m y o u r n o r m a l s e l f ? Did f r i e n d s or your f a m i l y t h i n k t h a n t h i s was more t h a n j u s t f e e l i n g good? D i d i t l a s t a t l e a s t one week? Were t h e s e t h i n g s under the i n f l u e n c e o f d r u g s or a l c o h o l ? (Do not i n c l u d e I f a p p a r e n t l y under the i n f l u e n c e of d r u g s or a l c o h o l i n t o x i c a t i o n )  2.  (At l e a s t t h r e e criteria.) During  the  symptoms p r e s e n t  t o meet DSM-IIIR  most s e v e r e p e r i o d  were you more a c t i v e t h a n u s u a l - e i t h e r s o c i a l l y , work, s e x u a l l y , or p h y s i c a l l y a c t i v e ? were you more t a l k a t i v e t h a n u s u a l t o keep on t a l k i n g ?  or  felt  a  at  pressure  d i d y o u r t h o u g h t s r a c e or d i d you t a l k so f a s t t h a t i t was d i f f i c u l t f o r p e o p l e t o f o l l o w what you were saying? d i d you special  f e e l you were a v e r y I m p o r t a n t p e r s o n , p l a n s , powers, t a l e n t s , or a b i l i t i e s ?  did  need  you  iess sleep  than  had  usual?  d i d you have t r o u b l e c o n c e n t r a t i n g on what was g o i n g on b e c a u s e y o u r a t t e n t i o n k e p t j u m p i n g t o u n i m p o r t a n t t h i n g s a b o u t you? d i d you do a n y t h i n g f o o l i s h t h a t c o u l d have g o t t e n you i n t o a l o t of t r o u b l e , l i k e b u y i n g t h i n g s , b u s i n e s s investments, sexual I n d i s c r e t i o n s , r e c k l e s s d r i v i n g ? 3.  (symptoms were so s e v e r e t h a t m e a n i n g f u l c o n v e r s a t i o n was i m p o s s i b l e , t h e r e was s e r i o u s Impairment In f u n c t i o n i n g , or he was h o s p i t a l i z e d . ) Were you h o s p i t a l i z e d ? Were you so e x c i t e d t h a t I t was a l m o s t i m p o s s i b l e t o h o l d a c o n v e r s a t i o n w i t h you? Did i t cause t r o u b l e s with p e o p l e , w i t h your f a m i l y , your work, or o t h e r u s u a l a c t i v i t i e s ?  163 Determining any evidence of a thought  disorder.  Has there been a time when you heard v o i c e s or other sounds t h a t other people couldn't hear? Have you ever had v i s i o n s or see t h i n g s that were not v i s i b l e to other people? What about strange smells or strange f e e l i n g s i n your body? Has there been a time when you had b e l i e f s or ideas that you l a t e r found out were not t r u e l i k e people being out to get you, or t a l k i n g about you behind your back? Have you ever c a l l a t t e n t i o n t o y o u r s e l f - l i k e d r e s s i n g l n some odd way or doing something strange? Have people ever had t r o u b l e understanding what you were s a y i n g because your speech was mixed up, or because you d i d n ' t make sense In the way you were talking?  I n q u i r i n g f o r p o s s i b l e o r g a n i c cause: During that time were you d r i n k i n g a l o t or had j u s t stopped? were you t a k i n g any drugs - l i k e LSD, speed? were you p h y s i c a l l y i l l  then?  165  Appendix Hamilton Rating  Scale  B for  Depression  Hamilton Rating  DEPRESSED MOOD: 0 1 2 3 4  Bcale  for  sadness, hopeless, vorthlessness  Depression  helplessness,  Absent These f e e l i n g s t a t e s I n d i c a t e d o n l y on q u e s t i o n i n g These f e e l i n g s t a t e s spontaneously r e p o r t e d v e r b a l l y Communicates f e e l i n g s t a t e s n o n - v e r b a l l y - i . e . , through f a c i a l e x p r e s s i o n , posture, v o i c e , and tendency t o weep P a t i e n t r e p o r t s VIRTUALLY ONLY these f e e l i n g s t a t e s i n h i s spontaneous v e r b a l and non-verbal communication.  FEELINGS OF GUILT 0 1 2 3 4  Absent S e l f - r e p r o a c h , f e e l s he has l e t people down Ideas of g u i l t or rumination over past e r r o r s or s i n f u l deeds. * Present I l l n e s s Is a punishment. Delusions of guilt. Hears a c c u s a t o r y or denouciatory v o i c e s and/or experiences t h r e a t e n i n g v i s u a l h a l l u c i n a t i o n s .  SUICIDE 0 1 2 3 4  Absent F e e l s l i f e Is not worth l i v i n g Wishes he were dead or any thoughts of p o s s i b l e death t o s e l f S u i c i d e ideas or gesture Attempts a t s u i c i d e (any s e r i o u s attempts r a t e s  4)  INSOMNIA EARLY 0 1 2  No d i f f i c u l t y f a l l i n g a s l e e p Complains of o c c a s i o n a l d i f f i c u l t y f a l l i n g a s l e e p i . e . , more than 1/2 hour Complains of n i g h t l y d i f f i c u l t y f a l l i n g asleep  INSOMNIA MIDDLE 0 1 2  No d i f f i c u l t y P a t i e n t complains of being r e s t l e s s and d i s t u r b e d d u r i n g the night Waking d u r i n g the n i g h t - any g e t t i n g out of bed  167 rates 6.  WORK AND 0 1 2  3  4  to  ACTIVITIES  No d i f f i c u l t y T h o u g h t s and f e e l i n g s o f i n c a p a c i t y , f a t i g u e , or weakness r e l a t e d t o a c t i v i t i e s , work, or h o b b i e s L o s s o f i n t e r e s t i n a c t i v i t y , h o b b i e s , or work e i t h e r d i r e c t l y r e p o r t e d by p a t i e n t , or i n d i r e c t l y i n l i s t l e s s n e s s , I n d e c i s i o n , and v a c i l l a t i o n ( f e e l s he has t o push h i m s e l f t o work o r a c t i v i t i e s ) D e c r e a s e In a c t u a l time s p e n t i n a c t i v i t i e s or decrease i n p r o d u c t i v i t y . In h o s p i t a l , r a t e 3 i f p a t i e n t d o e s n o t spend a t l e a s t t h r e e h o u r s a day i n a c t i v i t i e s ( h o s p i t a l j o b or h o b b l e s ) e x c l u s i v e of ward c h o r e s s t o p p e d w o r k i n g because o f p r e s e n t I l l n e s s . I n h o s p i t a l , r a t e 4 I f p a t i e n t engages i n no a c t i v i t i e s e x c e p t ward c h o r e s , or I f p a t i e n t f a i l s t o p e r f o r m ward c h o r e s u n a s s i s t e d  RETARDATION: s l o w n e s s of t h o u g h t and s p e e c h ; i m p a i r e d a b i l i t y t o c o n c e n t r a t e ; d e c r e a s e d motor a c t i v i t y 0 1 2 3 4  9.  of v o i d i n g )  No d i f f i c u l t y Waking i n e a r l y h o u r s of t h e m o r n i n g but goes back sleep U n a b l e t o f a l l a s l e e p a g a i n i f g e t s out o f bed.  2  8,  (except f o r purposes  INSOMNIA LATE 0 1  7.  2  Normal s p e e c h and t h o u g h t Slight retardation at interview Obvious r e t a r d a t i o n at i n t e r v i e w Interview d i f f i c u l t Complete s t u p o r  AGITATION 0 1 2  10.  None " P l a y i n g w i t h " hands, h a i r , e t c . Hand-wringing, n a i l - b i t i n g , h a l r - p u l l i n g , lips  biting  ANXIETY PSYCHIC 0 1 2 3  No d i f f i c u l t y S u b j e c t i v e t e n s i o n and i r r i t a b i l i t y W o r r y i n g a b o u t minor m a t t e r s Apprehensive a t t i t u d e apparent i n face  or  speech  of  168  4  Fears expressed  without  questioning  ANXIETY SOMATIC P h y s i o l o g i c a l concomitants of a n x i e t y , such a s : G a s t r o - i n t e s t i n a l - d r y mouth, w i n d , i n d i g e s t i o n , d i a r r h e a , cramps, b e l c h i n g , Cardlo-vascular - p a l p i t a t i o n s , headaches Respiratory - hyperventilation, sighing Urinary frequency Sweating 0 1 2 3 4  Absent Mild Moderate Severe Incapacitating SOMATIC  0 1  SYMPTOMS GASTRO-INTESTINAL  None Loss of a p p e t i t e but e a t i n g without s t a f f encouragement. Heavy f e e l i n g s i n abdomen D i f f i c u l t y e a t i n g without s t a f f urging. Requests or r e q u i r e s l a x a t i v e s o r m e d i c a t i o n f o r bowels o r m e d i c a t i o n f o r g a s t r o - l n t e s t i n a l symptoms.  2  SOMATIC 0 1  SYMPTOMS  GENERAL  None H e a v i n e s s i n l i m b s , back, o r h e a d . Backaches, headaches, or muscle a c h e s . L o s s o f e n e r g y and fatiguabillty Any c l e a r - c u t symptom r a t e s 2  2  GENITAL SYMPTOMS Symptoms s u c h a s : 0 1 2 3  loss of l i b i d o menstrual disturbances  Absent Mild Severe Not a s c e r t a i n e d  HYPOCHONDRIASIS 0 1 2 3  Not p r e s e n t Self-absorption (bodily) Preoccupation with health Frequent complaints, requests  f o rhelp, e t c .  169 4 16.  Hypochondrleal delusions  LOSS OF WEIGHT Rate A.  A or B  WHEN RATING BY HISTORY:  0 1  No w e i g h t l o s s Probable weight l o s s a s s o c i a t e d w i t h p r e s e n t illness D e f i n i t e (according t o p a t i e n t ) weight l o s s  2 B.  ON WEEKLY RATINGS BY WARD PSYCHIATRIST, WHEN ACTUAL WEIGHT CHANGES ARE MEASURED  0 1 2 17.  either  L e s s t h a n 1 pound w e i g h t l o s s i n week G r e a t e r t h a n 1 pound w e i g h t l o s s I n week G r e a t e r t h a n 2 pounds w e i g h t l o s s i n week INSIGHT  0 1  Acknowledges b e i n g d e p r e s s e d and i l l Acknowledges i l l n e s s b u t a t t r i b u t e s c a u s e t o bad f o o d , c l i m a t e , overwork, v i r u s , need f o r r e s t , e t c . Denies being i l l a t a l l  2 18.  DIURNAL VARIATION Rate b o t h A a n d B, b u t add 18B o n l y score A. 0 1 2  total  Note whether symptoms a r e worse I n m o r n i n g o r evening. I f NO d i u r n a l v a r i a t i o n , mark none. No v a r i a t i o n worse i n m o r n i n g worse i n e v e n i n g  B. 0 1 2 19.  into  When p r e s e n t , mark t h e s e v e r i t y Mark "none" i f NO v a r i a t i o n  of the v a r i a t i o n .  None Mild Severe DEPERSONALIZATION AND DEREALIZATION Such a s f e e l i n g s o f u n r e a l i t y , n i h i l i s t i c  0 1 2  Absent Mild Moderate  ideas  170  20.  3  Severe  4  Incapacitating  PARANOID SYMPTOMS 0 1 2  None S u s p i c i o u s ( d o u b t f u l or t r i v i a l ) More severe s u s p i c i o u s n e s s (e.g. o t h e r s wish him harm) Ideas of r e f e r e n c e Delusions of r e f e r e n c e and p e r s e c u t i o n  3 4 21.  OBSESSIONAL AND COMPULSIVE SYMPTOMS 0 1 2  22.  Absent Mild Severe  HELPLESSNESS 0 1  Not present S u b j e c t i v e f e e l i n g s which are e l i c i t e d o n l y by inquiry Patient volunteers h i s helpless f e e l i n g s Requires u r g i n g , guidance and reassurance t o accomplish ward chores or personal hygiene Requires p h y s i c a l a s s i s t a n c e f o r d r e s s , grooming, e a t i n g , bedside t a s k s , or personal hygiene  2 3 4  23.  HOPELESSNESS 0 1 2 3 4  24.  Not present I n t e r m i t t e n t l y doubts t h a t "things w i l l improve" but can be reassured C o n s i s t e n t l y f e e l s "hopeless" but accepts reassurances Expresses f e e l i n g s of discouragement, d e s p a i r , pessimism about f u t u r e , which cannot be d i s p e l l e d Spontaneously and i n a p p r o p r i a t e l y p e r s e v e r a t e s , " I ' l l never get w e l l " or i t s e q u i v a l e n t  WORTHLESSNESS: Ranges from mild l o s s of esteem, f e e l i n g s of i n f e r i o r i t y , s e l f - d e p r e c i a t i o n t o d e l u s i o n a l notions of worthlessness 0 1 2  Not present I n d i c a t e s f e e l i n g s of worthlessness ( l o s s of self-esteem) only on q u e s t i o n i n g Spontaneously i n d i c a t e s f e e l i n g s of worthlessness ( l o s s of self-esteem)  171 3 4  D i f f e r e n t from 2 by degree. P a t i e n t v o l u n t e e r s t h a t he i s "no good", " i n f e r i o r " , e t c . D e l u s i o n a l notions of v o r t h l e s s n e s s - e.g., "I am a heap of garbage" or i t s e q u i v a l e n t .  Appendix C Interview probes f o r the Hamilton Rating Scale for  Depression  173 i n t e r v i e w probes f o r the Hamilton Rating Scale (Based on Klerman, Welssman, R o u n s a v l l l e , and Chevron (1984)). Item 1: How have you been f e e l i n g ? Can you d e s c r i b e what your mood has been? Have you f e l t blue, down In the dumps, depressed? How bad has I t been? Have you wanted t o cry? Does c r y i n g help? Have you f e l t t h a t you would l i k e to c r y but t h a t you were beyond t e a r s ? Have you f e l t hopeless, unable t o c o n t r o l what happens t o you, a t the mercy of others or unable t o do anything f o r yourself? How have you f e l t about the f u t u r e ? getting better?  Can you see y o u r s e l f  Item 2: Have you blamed y o u r s e l f f o r t h i n g s you have done? Have you been down on y o u r s e l f ? Do you think t h a t you are a bad person? Have you f e l t t h a t you have l e t your f r i e n d s and f a m i l y down? Do you f e e l g u i l t y about i t ? Have you f e l t that you a r e t o blame f o r your i l l n e s s ? what way? Do you think about s i n ?  In  Item 3: Do you think much about death l a t e l y ? Have you f e l t t h a t l i f e was not worth l i v i n g ? Have you wished that you were dead? Have you had any thoughts of t a k i n g your l i f e ? Have you made any plans t o do so? Have you s t a r t e d to do t h i n g s t o work out that plan? Have you a c t u a l l y made an attempt on your  life?  Item 4: How have you been s l e e p i n g l a t e l y ? Any d i f f i c u l t i e s g e t t i n g to sleep? How often? How long does i t take you to f a l l asleep? Item 5; Once you f a l l asleep, do you s l e e p through the night? Are you r e s t l e s s , keep waking up? ( I f gets up, make sure t h a t  174 it of  i s f o r another bed?  Item Do to  reason  besides voiding)  Do  you  g e t up  out  6:  you wake e a r l y i n t h e m o r n i n g ? S t a y awake or f a l l back sleep. I s t h i s e a r l i e r t h a t you would n o r m a l l y g e t up?  Item  7:  How have you been d o i n g i n work, housework, h o b b i e s , i n t e r e s t s and s o c i a l l i f e ? I s t h i s any d i f f e r e n t t h a n you u s e d t o do? Item  what  10:  Have you you f e l t worrying  been f e e l i n g n e r v o u s , a n x i o u s or f r i g h t e n e d ? Have t e n s e or f o u n d i t h a r d t o r e l a x ? Have you been about l i t t l e t h i n g s ?  Have you terrible  have a f e e l i n g o f d r e a d , were a b o u t t o happen?  as  though  something  Have you t e n d e d t o become f e a r f u l l n any s p e c i a l s i t u a t i o n s u c h a s b e i n g a l o n e a t home, g o i n g o u t a l o n e , b e i n g l n crowds, t r a v e l l i n g , h e i g h t s , e l e v a t o r ? Item  11:  I am g o i n g t o r e a d o f f a l i s t o f symptoms. I would l i k e t o s a y y e s o r no whether you have any o f t h e f o l l o w i n g . (Read off l i s t o f symptoms. I f y e s t o any, ask a b o u t s e v e r i t y . ) Item How you  12: has y o u r a p p e t i t e been? stomach?  Have you been e a t i n g ? Do you somebody e l s e b e f o r e you w i l l Item  Have you  had  need encouragement eat?  ln  from  13:  Do do  you f e e l t i r e d e a s i l y ? A l l the time? anything? Do you s p e n d a l o t o f t i m e  Do  you  Item  a heavy f e e l i n g  have any  a c h e s and  pains?  I s I t an e f f o r t t o i n bed? Asleep?  F e e l i n g s of  heaviness?  14:  I am g o i n g t o ask you a few q u e s t i o n s a b o u t you s e x l i f e . Have you l o s t i n t e r e s t i n t h e o p p o s i t e s e x / your s p o u s e / your p a r t n e r ? Have you had l e s s s e x u a l d r i v e t h a n u s u a l ?  (for women) cycle? Item  Have you n o t i c e d any change i n your menstrual  15:  Do you t h i n k much about your h e a l t h ? worrying about your h e a l t h ? A l o t ? Item  Do you f i n d  16:  Have you l o s t weight s i n c e the t r o u b l e s t a r t e d ? Item  yourself  How  17:  What would you say i s the nature of your t r o u b l e ? caused i t ? Item  much?  what  18:  At what time of day do you f e e l best? Morning? Afternoon? Evening? At what time of day do you f e e l worst? Item  19:  Have you had the f e e l i n g at a l l that e v e r y t h i n g was that you were u n r e a l or that the world was d i s t a n t , strange, or changed? Item  unreal, remote,  20:  Are you s u s p i c i o u s of other people? Do you think people ar t a l k i n g about you or laughing behind your back? Item  21:  Do you f i n d unpleasant, f r i g h t e n i n g , or r i d i c u l o u s thoughts or words come i n t o your head and won't go away, even when you t r y to get r i d of them? Do you f i n d you have to keep checking or r e p e a t i n g t h i n g s you have a l r e a d y done? Do you have to do t h i n g s i n a s p e c i a l way, s p e c i a l order or a c e r t a i n number of times? Are you a f r a i d you might commit some t e r r i b l e a c t without wanting to?  Appendix D Beck Depression  Inventory  177  Beck  inventory  On t h i s q u e s t i o n n a i r e a r e g r o u p s o f s t a t e m e n t s . Please read each group of statements c a r e f u l l y . Then p i c k o u t t h e one s t a t e m e n t i n e a c h g r o u p w h i c h b e s t d e s c r i b e s t h e way you have been f e e l i n g t h e PAST WEEK INCLUDING TODAY. C i r c l e t h e number b e s i d e t h e s t a t e m e n t you p i c k e d . If several s t a t e m e n t s i n t h e g r o u p seem t o a p p l y e q u a l l y w e l l , c i r c l e e a c h one. Be s u r e t o r e a d a l l t h e s t a t e m e n t s i n e a c h g r o u p b e f o r e making y o u r c h o i c e . 1  0 1 2 3  I I I I  2  0 1 2 3  I am n o t p a r t i c u l a r l y d i s c o u r a g e d about t h e f u t u r e . I f e e l d i s c o u r a g e d about the f u t u r e . I f e e l l i k e n o t h i n g t o look forward t o . I f e e l t h a t t h e f u t u r e I s h o p e l e s s and t h a t t h i n g s c a n n o t Improve.  3  0 1  I do not f e e l l i k e a f a i l u r e . I f e e l t h a t I have f a i l e d more t h a n t h e a v e r a g e person. As I l o o k back on my l i f e , a l l I can s e e Is a l o t of f a i l u r e s . I f e e l I am a c o m p l e t e f a i l u r e as a p e r s o n .  2 3 4  O  l  do not f e e l s a d , f e e l sad. am s a d a l l t h e t i m e and I c a n ' t snap o u t o f i t . am so s a d or unhappy t h a t I c a n ' t s t a n d i t .  3  g e t as much s a t i s f a c t i o n out of t h i n g s as I used to. I d o n ' t e n j o y t h i n g s t h e way I used t o . I d o n ' t g e t r e a l s a t i s f a c t i o n out of a n y t h i n g any more. I am d i s s a t i s f i e d o r b o r e d w i t h e v e r y t h i n g .  5  0 1 2 3  1 I I I  6  O 1 2 3  7  0 1 2 3  1 I I I  8  0 1  I d o n ' t f e e l I am any worse t h a n anybody e l s e . I am c r i t i c a l o f m y s e l f f o r my weaknesses o r  1 2  l  don't f e e l p a r t i c u l a r l y guilty. f e e l g u i l t y a good p a r t o f the t i m e . f e e l q u i t e g u i l t y most o f t h e t i m e . f e e l g u i l t y a l l of the time.  d o n ' t f e e l I am b e i n g p u n i s h e d . I f e e l I may be p u n i s h e d . I e x p e c t t o be p u n i s h e d . I f e e l I am b e i n g p u n i s h e d . don't f e e l d i s a p p o i n t e d l n myself. am d i s a p p o i n t e d i n m y s e l f . am d i s g u s t e d w i t h m y s e l f . hate myself.  178 mistakes. I blame m y s e l f I blame m y s e l f  2 3 9  0 1  1 d o n ' t have any t h o u g h t s o f k i l l i n g m y s e l f . I have t h o u g h t s o f k i l l i n g m y s e l f , b u t I would c a r r y them o u t . I would l i k e t o k i l l m y s e l f . I would k i l l m y s e l f i f I had t h e c h a n c e .  2 3 10  11  0.1 d o n ' t c r y any more t h a n u s u a l . 1 I c r y more now t h a n I u s e d t o . 2 I c r y a l l the time now. 3 I used t o be a b l e t o c r y , but now though I want t o . 0 1 2 3  12  0 1 2 3  13  0 1 2 3  14  0 1 2 3  15  0 1 2 3  16  a l l t h e t i m e f o r my faults. f o r e v e r y t h i n g bad t h a t h a p p e n s .  0 1 2 3  not  I c a n ' t c r y even  I am no more i r r i t a t e d now t h a n I e v e r am. I g e t annoyed or i r r i t a t e d more e a s i l y t h a n I used to. I f e e l i r r i t a t e d a l l the time now. I d o n ' t g e t i r r i t a t e d a t a l l by the t h i n g s t h a t used t o I r r i t a t e me. 1 i to I I  have not l o s t i n t e r e s t i n o t h e r p e o p l e . am l e s s i n t e r e s t e d i n o t h e r p e o p l e t h a n I used be. have l o s t most o f my i n t e r e s t i n o t h e r p e o p l e . have l o s t a l l my i n t e r e s t i n o t h e r p e o p l e .  1 make d e c i s i o n s a b o u t a s w e l l as I e v e r c o u l d . I put o f f making d e c i s i o n s more t h a n I used t o . I have g r e a t e r d i f f i c u l t y i n making d e c i s i o n s than b e f o r e . I c a n ' t make d e c i s i o n s a t a l l anymore. I d o n ' t f e e l I l o o k any worse t h a n I used t o . I am w o r r i e d t h a n I am l o o k i n g o l d or unattractive. I f e e l t h a t t h e r e a r e permanent changes i n my a p p e a r a n c e t h a t make me l o o k u n a t t r a c t i v e . I believe that I look u g l y . 1 can work about as w e l l as b e f o r e . I t t a k e s an e x t r a e f f o r t t o g e t s t a r t e d a t d o i n g something. I have t o push m y s e l f v e r y h a r d t o do a n y t h i n g . I c a n ' t do any work a t a l l . 1 c a n s l e e p as w e l l as u s u a l . I d o n ' t s l e e p as w e l l a s I used t o . I wake up 1-2 h o u r s e a r l i e r t h a n u s u a l and f i n d i t h a r d t o g e t back t o s l e e p . I wake up s e v e r a l h o u r s e a r l i e r t h a n I u s e d t o and c a n n o t g e t back t o s l e e p .  179  17  0 1 2 3  I I I I  18  0 1 2 3  My a p p e t i t e i s no worse t h a n u s u a l . My a p p e t i t e i s n o t as good as i t used My a p p e t i t e i s much worse now. I have no a p p e t i t e a t a l l anymore.  19  0 1 2 3  I I I I  20  0 1  I am no more w o r r i e d a b o u t my h e a l t h t h a n u s u a l . I am w o r r i e d a b o u t p h y s i c a l problems s u c h a s a c h e s and p a i n s , o r u p s e t stomach, o r c o n s t i p a t i o n I am v e r y w o r r i e d a b o u t p h y s i c a l p r o b l e m s and I t ' s h a r d t o t h i n k o f much e l s e . I am so w o r r i e d a b o u t my p h y s i c a l p r o b l e m s t h a t I cannot think about a n y t h i n g e l s e .  2 3 21  0 1 2 3  d o n ' t g e t more t i r e d t h a n u s u a l . g e t t i r e d more e a s i l y t h a n I used t o . g e t t i r e d from d o i n g almost a n y t h i n g . am t o o t i r e d t o do a n y t h i n g . t o be.  h a v e n ' t l o s t much w e i g h t , i f any, l a t e l y . have l o s t more t h a n 5 pounds. have l o s t more t h a n 10 pounds. have l o s t more t h a n 15 pounds. I am p u r p o s e l y t r y i n g t o l o s e w e i g h t by e a t i n g l e s s . Yes No  I have n o t n o t i c e d a n y r e c e n t change i n my i n t e r e s t i n sex. I am l e s s i n t e r e s t e d i n s e x t h a n I used t o be. I am much l e s s i n t e r e s t e d i n sex now. I have l o s t I n t e r e s t i n s e x c o m p l e t e l y .  Appendix E DSM-III-R diagnoses f o r Major Depressive Episode and Dysthmia  181 C r i t e r i a f o r Major Depressive Episode or Dysthymla a c c o r d i n g to the D i a g n o s t i c and S t a t i s t i c a l Manual of Mental Disorder (3rd ed. - r e v i s e d ; American P s y c h i a t r i c A s s o c i a t i o n , 1987): Major Depressive Episode: A. At l e a s t f i v e of the f o l l o w i n g symptoms have been present during the same two-week p e r i o d and r e p r e s e n t a change from previous f u n c t i o n i n g ; at l e a s t one of the symptoms i s e i t h e r (1) depressed mood, or (2) l o s s of I n t e r e s t or pleasure. 1. depressed mood 2. diminished I n t e r e s t or pleasure i n a l l , or almost a l l , a c t i v i t i e s most of the day, n e a r l y a l l day 3. s i g n i f i c a n t weight l o s s or weight g a i n when not dieting 4. insomnia or hyposomnia n e a r l y every day 5. psychomotor r e t a r d a t i o n or a g i t a t i o n n e a r l y every day 6. f a t i g u e or l o s s of energy n e a r l y every day 7. f e e l i n g s of worthlessness or e x c e s s i v e or Inappropriate g u i l t 8. diminished a b i l i t y to think or concentrate, or i n d e c i s i v e n e s s , n e a r l y every day B. 1. not due to an organic f a c t o r 2. not a normal r e a c t i o n to the death of a loved one C. Absence of d e l u s i o n s or h a l l u c i n a t i o n s D. Not superimposed on S c h i z o p h r e n i a , Schizophreniform D i s o r d e r , D e l u s i o n a l D i s o r d e r , or P s y c h o t i c Disorder (American P s y c h i a t r i c A s s o c i a t i o n , 1987,  p. 128-129.)  Dysthymla A. Depressed mood for most of the day, f o r at l e a s t two y e a r s . B. Presence, while depressed, of at l e a s t two of the following: 1. poor a p p e t i t e or o v e r e a t i n g 2. insomnia or hypersomnia 3. low energy or f a t i g u e 4. low s e l f - e s t e e m 5. poor c o n c e n t r a t i o n or d i f f i c u l t y making decisions 6. f e e l i n g s of hopelessness C. During a two-year p e r i o d of the d i s t u r b a n c e , never without the symptoms i n A f o r more than two months at a time. D. No evidence of Major Depressive Episode during the f i r s t two years of the d i s t u r b a n c e . E. Absence of Manic Episode or Hypomania Episode F. Not superimposed on a c h r o n i c p s y c h o t i c d i s o r d e r , such as Schizophrenia or D e l u s i o n a l D i s o r d e r .  G. Not due t o an o r g a n i c c a u s e . (American P s y c h i a t r i c A s s o c i a t i o n ,  1987,  p.  136-137).  Appendix F L i s t of medications f o r c u r r e n t l y ' depressed and remitted depressed groups  184 L i s t of p s y c h i a t r i c medications f o r c u r r e n t l y depressed and remitted depressed s u b j e c t s C u r r e n t l y depressed s u b j e c t s Nortriptyline Trazadone Desipramine Lorazepan Panit idine Atenolol Nitrong Serax Hellaril Clonazepan L i t h i u m Carbonate Prozac Fluoxetine Imipramlne Atovam MAO I n h i b i t o r with L-troptophan Loprax Rivotrll Phenelzine Medobouride Amitriptyllne Doxepin Remitted depressed s u b j e c t s Phenelzene Imipramlne Clomipramine Lorazepan Desipramine Lithium Anafravll Lorimil  .  185  Appendix G consent forms  188  Appendix H Interview  189 interview  Subject number Date Interviewer I.  Assessment of demographic  Information.  Now I would l i k e to ask you some general q u e s t i o n s about yourself. 1.  How  o l d are you?  2.  Are you working at What do you (or)  present?  do?  Have you ever worked? or l i v i n g  What d i d you used to  3.  Are you married  4.  Do you have any c h i l d r e n ?  5.  How f a r d i d you get i n school? Did you r e c e i v e any s p e c i a l t r a i n i n g ?  do?  with somebody?  Now I am going to ask you a standard s e t of q u e s t i o n s . The q u e s t i o n s w i l l cover some of the kinds of problems or d i f f i c u l t i e s t h a t many people have at some time d u r i n g t h e i r lives. Some of the questions may not be a p p l i c a b l e but i t i s important to ask them of everybody. II. Now  Assessment of c u r r e n t d e p r e s s i o n . I am going to ask you how you are f e e l i n g at present. (Administer Hamilton)  III. Assessment of p s y c h i a t r i c (administer SADS here)  history  Appendix I S t i m u l i for the d i c h o t i c l i s t e n i n g task  191 Table  1:  Practice  Storle3 3torles  The o l d man g a t h e r e d h i s t h r e e g r a n d c h i l d r e n a r o u n d . He p l a n n e d t o t a k e them t o t h e c i r c u s t o n i g h t . The c i r c u s s t a r t e d a t 8:30 so t h e y l e f t t h e house a t 6:30. They p i l e d i n t h e c a r and s t a r t e d out f o r t h e c i r c u s . When t h e y a r r i v e d a t t h e c i r c u s , most o f t h e t i c k e t s had been s o l d b u t t h e y managed t o buy t i c k e t s f o r t h e m s e l v e s . Jane wanted t o s t a r t her s p r i n g c l e a n i n g t o d a y . She c a l l e d i n her f a m i l y and a s s i g n e d a l i s t o f d u t i e s . E a c h member o f t h e f a m i l y was a s s i g n e d t o a d i f f e r e n t room. Things t h a t were t o be thrown out were p l a c e d on t h e p o r c h . A t t h e end of t h e d a y t h e r e was a huge p i l e o f junk on t h e f r o n t l a w n . Target  stories  On S a t u r d a y m o r n i n g , t h e w e a t h e r was m i l d and sunny. After f i n i s h i n g h i s c h o r e s o f w a s h i n g t h e c a r and b u y i n g t h e w e e k l y g r o c e r i e s , J o h n d e c i d e d t o go f o r a b i c y c l e r i d e . He rode a l o n g the r i v e r path. I t s t a r t e d to r a i n , f i r s t s o f t l y , t h e n g r a d u a l l y t h e r a i n s t a r t e d t o f a l l more s t e a d i l y and more h e a v i l y u n t i l i t p o u r e d . John r a c e d home. J a n e was g o i n g t o have e i g h t d i n n e r g u e s t s t o n i g h t . She a s k e d h e r husband t o s e t up t h e d i n i n g room w h i l e she r a n her e r r a n d s . She f i r s t went t o t h e g r o c e r y s t o r e where s h e . b o u g h t a r o a s t , c a r r o t s , p o t a t o e s , and b r e a d . She went t o t h e c l e a n e r s t o p i c k up her d r e s s . She t h e n vent- hone and put the r o a s t i n the o v e r . A f t e r b e i n g i n t h e house a l l day, t h e dog was f i n a l l y l e t out. He s n i f f e d t h e c o l d a i r and w a l k e d o v e r t o h i s w a t e r dish. He t r i e d t o d r i n k from i t b u t t h e w a t e r was f r o z e n . He w a l k e d o v e r t o h i s l e a s h , p u t i t i n h i s mouth, and s c r a t c h e d a t t h e door i n hopes o f b e i n g t a k e n f o r a w a l k . John's j o b i s to d e l i v e r newspapers, s i n c e i t was t h e end of t h e month, he a l s o had t o c o l l e c t payments. F i r s t , John went t o t h e bank t o g e t s m a l l b i l l s so he c o u l d g i v e change to h i s customers. Next, he went home t o g e t h i s r e c e i p t book and an e n v e l o p e t o p u t t h e money i n . He t h e n s t a r t e d h i s paper r o u t e .  192  Table  2.  Recognition  task  i n t h e c h a n n e l t h a t you were s u p p o s e d t o I g n o r e , t h e r e were some words p r e s e n t e d on t h a t c h a n n e l . Here i s a l i s t of w o r d s . Were any o f t h e s e words on t h a t c h a n n e l ? I f you are unsure, take a guess. T r y t o be a s a c c u r a t e a s y o u c a n b u t d o n ' t s p e n d t o o much t i m e on a n y one word.  were t h e s e  words on t h a t  channel?  Y/N 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29 . 30. 31. 32. 33. 34. 35.  weary robust lively forlorn sorry encouraged eager witty miserable despairing destitute amusing relaxed sociable bleak successful fortunate gr i e v e d gloomy guilty suicidal burdened satisfied anguished beaten merry refreshed bold downcast carefree capable gloomy shattered deserted contented  Y/N 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60.  devastated deficient regretful dynamic jovial apathetic entertaining respected bubbly abandoned drained playful achieving afflicted cheerful worthless remorseful delighted joyful melancholy tearful giggly wretched optimistic outgoing  193  Appendix J Analyses o£ v a r i a n c e f o r the listening  task  dichotic  Table 1 ANOVA Summary Table f o r D e t e c t i o n L a t e n c i e s  Source of v a r i a t i o n  df  Between s u b j e c t s Groups Subjects w.groups  2 57  130207.66 54715.50  Within s u b j e c t s Content word Group x content word Content x s u b j e c t w.group  1 2 57  1320.03 71502.06 17155.84  Note .  Ms  2.38  .08 4.17 *  p_ < .05  Table 2 ANOVA Summary Table f o r Shadowing E r r o r s  Source of v a r i a t i o n Between s u b j e c t s Groups Subjects w.groups Within s u b j e c t s Content word Group x content word Content x s u b j e c t w.group Note. * p. < .05  df  5  Ms  2  5.61 1.81  1 2 57  .41 .61 2.00  7  3.10 *  .20 .30  Table 3 ANOVA Summary Table  f o r R e c o g n i t i o n Performance  source of v a r i a t i o n  df  Between s u b j e c t s Groups Subjects w.groups  2 57  77.60 18.74  4.14 *  1 2 57  11.70 .72 . 84  14.01*** .86  Within s u b j e c t s Response ( h i t / m i s s ) Group x Response Response x s u b j e c t s w.groups  Ms  Content Group x content Content x s u b j e c t s w.groups  1 2 57  16.54 1 40 5 76  Response x content Response x content x group Response x content x s u b j e c t w.groups  1 2 57  11.70 .32 .87  Note.  *** p_ < .001 * p_ < .05  F  2.87 .24 13 . 50*** . 37  Appendix K A n a l y s i s of v a r i a n c e f o r the probe d e t e c t i o n task  197  ANOVA summary t a b l e  for detection  latencies  Source of v a r i a t i o n  df  Between s u b j e c t s Groups Subjects w.groups  2 57  528516.37 115257.25  4.59  Within s u b j e c t s Content word 2 Group x content word 4 Content x s u b j e c t w.group 114  6916.56 13587.33 9360.65  .74 1.45  Word p o s i t i o n 1 Group x word p o s i t i o n 2 Word p o s i t i o n x s u b j e c t s 57 w.groups  27380.00 19551.12 10343.79  2.65 1,89  Content x word p o s i t i o n 2 Group x content x word 4 position Content x word p o s i t i o n x 114 s u b j e c t s w.groups  12118.95 12055.41  1.52 1. 52  Probe p o s i t i o n Group x probe p o s t i o n Probe p o s i t i o n x s u b j e c t s w.groups  Ms  7950.12  1 2 57  863478.27 55952.67 25003.81  Content x word p o s i t i o n 2 Group x word pos x content 4 Word pos x content x 114 s u b j e c t s w.groups  42706.11 23444.04 12835.38  Probe p o s i t i o n x content Group x probe x content Probe x content x s u b j e c t s w.groups Content x word p o s i t i o n x probe p o s i t i o n Group x content x word x probe Content x word x probe x s u b j e c t s w.groups Note.  * ***  +  p_ < .05 p_ < .001  *  34.53*** 2.24  3.33 + 1.83  1 2 57  17306.81 411.54 6628.36  2.61 .06  2  1090.59  .15  4  8530.46  1.14  114  7474.66  p_ < .05 with Greenhbuse-Geisser  correction  Appendix L Analyses of v a r i a n c e f o r the memory task  iraplic  9  199  Table 1 ANOVA Summary T a b l e Source  for Implicit  of v a r i a t i o n  Memory  Performance  df  Between s u b j e c t s Groups C o n d i t i o n (primed vs Group x c o n d i t i o n S u b j e c t s w.groups  Ms  3.95 33.49 2.09 1.82  unprimed)1 2 54  Within subjects C o n t e n t word 3 Group x c o n t e n t word 6 Content x c o n d i t i o n 3 Content x c o n d i t i o n x group 6 Content x c o n d i t i o n x group 162 x s u b j e c t s w. g r o u p s Note.  *** p. < .001 + p_ < .05 w i t h G r e e n h o u s e - G e i s s e r  1.25 .28 2.59 2.15 .96  2.17 18.41*** 1.15  1.30 .29 2.69 + 2.24 +  corrections  Table 2 ANOVA Summary T a b l e Source  for Explicit  of v a r i a t i o n  Memory Task  df  Performance  Ms  F  Between s u b j e c t s Groups S u b j e c t s w.groups  2 27  .84 2.79  Within subjects C o n t e n t word Group x c o n t e n t word C o n t e n t x s u b j e c t w.group  3 6 81  20.48 .63 .72  Note.  +++  p_ < .001 w i t h G r e e n h o u s e - G e i s s e r  .30  28.52+++ .88  correction  200  Appendix M Automatic Thoughts  Questionnaire  201 Automatic  Thoughts Q u e s t i o n n a i r e  L i s t e d below are a v a r i e t y of thoughts t h a t pop i n t o people's heads. Please read each thought and i n d i c a t e how f r e q u e n t l y , i f a t a l l , the thought occurred to you over the l a s t day. Please read each item c a r e f u l l y and c i r c l e the a p p r o p r i a t e answers on the answer sheet In the f o l l o w i n g f a s h i o n (1 = "not at a l l " , 2 = "sometimes", 3 = "moderately o f t e n " , 4 = " o f t e n " , and 5 = " a l l the t i m e " ) . Response 12 3 4 5 1 2 3 4 5 12 3 4 5 12 3 4 5 1 2 3 4 5 12 3 4 5 12 3 4 5 1 2 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 1 2 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 1 2 3 4 5 12 3 4 5 1 2 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5 12 3 4 5  I terns 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) 29) 30)  I f e e l l i k e I'm up a g a i n s t the world. I'm no good. Why can't I ever succeed? No one understands me. I've l e t people down. I don't think I can go on. I wish I were a b e t t e r person. I'm so weak. My l i f e ' s not going the way I want i t to I'm so d i s a p p o i n t e d i n myself. Nothing f e e l s good anymore. I can't stand t h i s anymore. I can't get s t a r t e d . What's wrong with me. I wish I were somewhere e l s e . I can't get things t o g e t h e r . I hate myself. I'm worthless. Wish I could j u s t d i s a p p e a r . What's the matter with me? I'ma loser. My l i f e i s a mess. I'ma failure. I ' l l never make i t . I f e e l so h e l p l e s s . Something has to change. There must be something wrong with me. My f u t u r e i s bleak. I t ' s j u s t not worth i t . I can't f i n i s h a n y t h i n g .  202  Appendix N Hopelessness Scale  203  T h i s q u e s t i o n n a i r e c o n s i s t s o£ a l i s t o£ t w e n t y s t a t e m e n t s . P l e a s e r e a d t h e s t a t e m e n t s c a r e f u l l y one by one. I f t h e s t a t e m e n t d e s c r i b e s y o u r a t t i t u d e f o r t h e p a s t week, i n c l u d i n g t o d a y , w r i t e down TRUE n e x t t o i t . I f t h e s t a t e m e n t i s f a l s e f o r y o u , w r i t e FALSE n e x t t o I t . You may s i m p l y w r i t e T f o r TRUE and F f o r F A L S E . P l e a s e be s u r e t o read each s e n t e n c e . 1.  I look forward enthusiasm.  2.  I m i g h t as w e l l g i v e up b e c a u s e t h e r e ' s n o t h i n g I c a n do a b o u t making t h i n g s b e t t e r f o r m y s e l f .  3.  When t h i n g s a r e g o i n g b a d l y , I am knowing t h a t t h e y c a n ' t s t a y t h a t  4.  I c a n ' t imagine ten y e a r s .  5.  I have enough t i m e most want t o do.  6.  In t h e f u t u r e I e x p e c t c o n c e r n s me most.  7.  My  8.  I h a p p e n t o be p a r t i c u l a r l y l u c k y and I e x p e c t get more o f t h e good t h i n g s i n l i f e t h a n t h e average person.  9.  I j u s t d o n ' t g e t t h e b r e a k s , and t h e r e ' s no reason t o b e l i e v e I w i l l i n the f u t u r e .  future  t o the  future  what my  life  w i t h hope  would  h e l p e d by way f o r e v e r . be  like ln  to accomplish the t h i n g s I  seems d a r k  to succeed  to  i n what  me.  10.  My p a s t e x p e r i e n c e s have p r e p a r e d me future.  11.  A l l I can rather  and  s e e ahead o f me  Is  well  for  to  my  unpleasantness  than pleasantness.  12.  I don't  13.  when I l o o k ahead t o t h e f u t u r e I e x p e c t I w i l l be h a p p i e r t h a t I am now. T h i n g s j u s t won't work out t h e way I want them  14.  expect  t o g e t what I r e a l l y want.  to. 15.  I have g r e a t f a i t h i n t h e  16.  I n e v e r g e t what I want so I t ' s f o o l i s h t o want ' anything.  future.  204  17.  I t i s v e r y u n l i k e l y t h a t I w i l l get any s a t i s f a c t i o n i n the f u t u r e .  real  18.  The  me.  19.  I can look forward to more good times than times.  20.  There's no use i n r e a l l y t r y i n g to get something I want because I probably won't get i t .  f u t u r e seems vague and  uncertain to  bad  205  Appendix Dysfunctional  0  Attitude  Scale  206  T h i s i n v e n t o r y l i s t s d i f f e r e n t a t t i t u d e s or b e l i e f s which people sometimes hold. Read each statement c a r e f u l l y and decide how much you agree or d i s a g r e e with the statement. To decide whether a given a t t i t u d e i s t y p i c a l of your way of l o o k i n g a t t h i n g s , simply keep i n mind what you are l i k e MOST OF THE TIME. 1. I t i s d i f f i c u l t to be happy u n l e s s one Is good l o o k i n g , I n t e l l i g e n t , r i c h , and c r e a t i v e . 2. Happiness i s more a matter of my a t t i t u d e towards myself than the way other people f e e l about me. 3. People w i l l probably t h i n k l e s s of me I f I make a mistake. 4. I f I do not do well a l l the time, people w i l l not r e s p e c t me. 5. Taking even a small r i s k l i k e l y t o be a d i s a s t e r .  i s f o o l i s h because  the l o s s i s  6. I t i s p o s s i b l e to g a i n another person's r e s p e c t without being e s p e c i a l l y t a l e n t e d a t a n y t h i n g . 7.  I cannot be happy u n l e s s most people I know admire  8.  I f a person asks f o r h e l p , I t Is a s i g n of weakness.  me.  9. I f I do not do as w e l l as other people, i t means I am an i n f e r i o r human being. 10.  I f I f a i l at my work, then I am a f a i l u r e as a person.  11. I f you cannot do something i n doing i t a t a l l . 13.  w e l l , there i s l i t t l e  Making mistakes i s f i n e because  point  I can l e a r n from them.  13. I f someone d i s a g r e e s with me, i t probably i n d i c a t e s he does not l i k e me. 14. If I f a i l failure.  p a r t l y , i t i s as bad as being a complete  15. I f other people know what you a r e r e a l l y l i k e , w i l l t h i n k l e s s of you. 16.  they  I am nothing i f a person I love doesn't love me.  17. One can get pleasure from an a c t i v i t y r e g a r d l e s s of the end r e s u l t . . ,  18. People should have a reasonable l i k e l i h o o d of success before undertaking a n y t h i n g . 19. My value as a person depends g r e a t l y on what others think of me. 20. I f I don't set the h i g h e s t standards f o r myself, I am l i k e l y to end up a second-rate person. 21. I f I am to be a worthwhile person, I must be o u t s t a n d i n g i n a t l e a s t one major r e s p e c t . 22. People who who do not. 23.  have good ideas are more worthy than others  I should be upset i f I make a mistake.  24. My own opinions of myself are more Important other's o p i n i o n s of me. 25. To be a good, moral, worthwhile everyone who needs I t . 26.  truly  than  person, I must h e l p  I f I ask a q u e s t i o n , i t makes me  look  inferior.  27. I t Is awful to be disapproved of by people Important you.  to  28. "If you don't have other people to lean on, you are bound t o be sad. 29. I can reach Important myself.  goal without slave d r i v i n g  30. I t i s p o s s i b l e f o r a person t o be scolded and not get upset. 31. to 32.  I cannot t r u s t other people because me.  they might be  cruel  I f others d i s l i k e you, you cannot be happy.  33. I t i s best to give up your own please other people.  i n t e r e s t s i n order t o  34. My happiness depends more on other people that i t does on me. 35. I do not need the approval of other people i n order t o be happy. 36.  I f a person avoids problems,  the problems tend t o go .;,  37. I can be happy even i£ I miss out on many o£ the good things i n l i f e . 38.  What other people t h i n k about me Is v e r y  Important.  39. Being I s o l a t e d from others i s bound t o lead to unhappiness. 40. I can f i n d happiness without being loved by another person.  209  Appendix Analyses  of V a r i a n c e Self-report  and  P Covariance  Questionnaires  f o r the  210  Table 1 ANOVA Summary Table  f o r the DAS  Source of v a r i a t i o n  df  Between s u b j e c t s Subjects w.groups  1 57  Note.  ***  MS 22812. 92 1641. 29  F 13. 9 0 * * *  D < .001  Table 2 ANOVA Summary Table f o r the HS  Source of v a r i a t i o n  df  MS  Between s u b j e c t s Subjects w.groups  1 57  645. 02 17. 81  Note.  ***  F 36. 2 2 * * *  p_ < .001  Table 3 ANOVA Summary Table  f o r the ATQ  Source of v a r i a t i o n  df  Between s u b j e c t s Subjects w.groups  1 57  Note.  ***  p. < .001  Ms 31817 .22 384 .23  F 82.81***  Table 4 A n a l y s i s of Covariance  f o r HS  Source of v a r i a t i o n  df  Ms  Between s u b j e c t s Subjects w.groups  1 37  9.47 6.47  F 1.46  Table 5 A n a l y s i s of Covariance for  ATQ  Source of v a r i a t i o n  di  MS  F  Between s u b j e c t s Subjects w.groups  1 37  191.68 128.99  1.50  212  Appendix Q C o r r e l a t i o n Tables of Measures by Group  213 Table 1 Correlations of Measures for the Currently Depressed Group B2 B2 1.0 DL .15 PD .01 IM - .29 Bl .75 ATQ .66 HS .30 DAS .30 AGE .34 ED - .17 SES .31 FREQ .50  DL 1.0 .24 .15 .38 .14 -.18 -.11 -.25 -.17 .43 -.35  PD  IM  Bl  ATQ  HS  DAS  AGE  ED  1.0 -.14 1.0 -.11 .12 1.0 -.14 .00 .74 1.0 -.18 .21 .48 .70 1.0 .19 .14 .30 .34 .62 1.0 -.07- .11 .28 .21 .07 -.17 1.0 -.07- .17--.12 -.14 .00 .19 -.02 1.0 .22- .24 .25 .26--.01 -.05 -.41 -.79 .16- .01 . 25 . 36 .45 .39 -.02 -.14  SES  FREQ  1.0 .19  1.0  Table 2 Correlations of Measures for the Remitted Depressed Group B2 B2  DL PD IM  1.0  DL  .08 1.0 .34 - . 3 2 . 47 - . 0 7 Bl .36 .24 .18 ATQ .63 HS . 56 .21 DAS .15 .05 AGE-.25 - . 4 9 ED - . 2 3 - . 1 4 SES-.03 .19 FREQ.06 .01  PD  IM  1.0 -.12  1.0  Bl  ATQ  HS  DAS  AGE  ED  SES  FREQ  .22 .15 1.0 - . 0 2 .60 .66  1.0 - . 0 1 .44 .68 .86 1.0 .47 .71 1.0 - . 2 5 .08 .46 .41- - . 2 0 - . 0 8 - . 3 0 - . 5 2 - . 4 7 1.0 .09 .07 .12 - . 1 0 1.0 - . 2 2 .38 - . 3 1 .03 - . 1 9 .05 - . 1 4 - . 2 9 - . 4 6 .22-- . 4 7 - . 1 7 .13 - . 1 9 - . 0 9 .14 .13 - . 2 1 .09  1.0 1.0  -.49  Table 3 correlations of Measures for the Nondepressed Group B2 DL 1.0 1.0 DL .36 PD --.29 - . 1 0 IM --.32 - . 1 3 Bl .52 .12 ATQ .46 .26 HS --.07 -.12 DAS .38 .08 AGE .01 .16 B2  PD 1.0 -.10 -.40-.41-.27-.20.21  IM  Bl  ATQ  1.0 .50 1.0 .34 .75 1.0 .23 -.03 - . 0 6 .29 .29 .34 .32 -.45 -.32  HS  DAS  AGE  ED  SES  •  1.0 .34 1.0 .01 - . 0 5  FREQ  -  1.0 .1,  214 ED -.11 .03 .30 .00-.48 -.15 .21 -.01 SES .26 -.24 .08-.23 .37 - . 0 3 - . 2 3 -.07 FREQ.00  .34 1.0 .09-.09 1.0  .00 .00 .00 .00 .00 .00 .00 .00 .00  .00 1.0  Note . B2 = Time 2 Beck Depression Inventory s c o r e s . DL = Composite score from the d i c h o t l c l i s t e n i n g task d e r i v e d from r e a c t i o n times of depression words r e a c t i o n times of p o s i t i v e words. PD = Composite score from the probe d e t e c t i o n task d e r i v e d from r e a c t i o n times of d e p r e s s i o n words - r e a c t i o n times of p o s i t i v e words. IM = Composite score from the i m p l i c i t memory task d e r i v e d from depression words generated that were p r e v i o u s l y r a t e d - p o s i t i v e words generated t h a t were p r e v i o u s l y rated.  Bl = ATQ= HS = DAS= AGE= ED = SES=  Time 1 Beck Depression Inventory s c o r e s . Automatic Thoughts Questionnaire s c o r e s . Hopelessness Scale s c o r e s . D y s f u n c t i o n a l A t t i t u d e Scale s c o r e s . Age i n years. Number of years of education. Socioeconomic s t a t u s r a t i n g s based on B l i s h e n and McRoberts ( 1 9 7 6 ) . FREQ=frequency of previous d e p r e s s i v e episode.  

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